Dialysis Related Amyloid Arthropathy on 18FDG PET-CT

A 60 year-old male patient with end stage kidney disease secondary to Alport syndrome presented with worsening swelling and pain in both shoulders. He had been on regular haemodialysis for 20 years, having had two failed renal transplants previously and had renal amyloidosis confirmed on renal biopsy. Radiographs of the shoulders showed evidence of an erosive arthropathy affecting the glenohumeral and acromioclavicular joints without significant degenerative change (Figure 1). In view of advanced renal failure and contraindication to MRI, a PET-CT scan was performed with 18-fluorodeoxyglucose (FDG) to assess for amyloid involvement in the shoulders. This demonstrated periarticular radiotracer uptake in both shoulder joints with greater involvement on the left, compatible with bilateral amyloid arthropathy in the shoulder joints (Figure 2).