Scintigraphy-Positive Light-Chain Cardiac Amyloidosis

We report the cases of 3 patients with biopsy-proven light-chain cardiac amyloidosis (AL-CA) presenting with varying clinical manifestations and abnormal findings on Tc-based bone-avid scintigraphy, illustrating the diagnostic challenges of distinguishing AL-CA from transthyretin-related CA. All patients demonstrated typical electrocardiographic and echocardiographic features of CA, including low voltage and apical-sparing strain pattern. Despite abnormal scintigraphy suggestive of transthyretin-related CA, concurrent abnormal light-chain assays raised diagnostic uncertainty. Endomyocardial biopsy with mass spectrometry confirmed AL-CA in all cases. These cases emphasize the heterogeneous presentation of CA and the essential role of light-chain assays, regardless of the presence of myocardial uptake pattern on scintigraphy.