CASE PRESENTATION: A 63-year-old male, was referred to our clinic for evaluation of bilateral lung nodules. He has a 10-pack-year smoking history, quit 25 years back, who had a CT chest for evaluation of cough that had started an year ago. It was associated with weight loss, hemoptysis and exertional dyspnea. He has hypertension, treated with olmesartan, currently taken off due to orthostasis. His physical exam, including vital signs, and labs (CBC, CMP, PFTs) were within normal limits. His CT chest showed bilateral multiple ground glass nodules and mediastinal adenopathy. He underwent an EBUS-TBNA, which was negative for malignancy, showing benign lymphoid tissue. After a scan in 3 month demonstrated interval worsening in number of these nodules, he underwent a VATS wedge biopsy, which was consistent with PCH, confirmed by two pathology referral centers. His echo showed an EF of 65%, severe biventricular hypertrophy, severe diastolic dysfunction (LA size 5.2 cm) and an RVSP of 45 mm Hg. He underwent a right heart cath: RA mean 13 mmHg, RV 60/11, PA 65/20, PA mean 36, PCWP 22, PVR 3.02 woods unit, CI 2.19 and CO (thermodilution) 4.63 L/min. His endomyocardial biopsy demonstrated cardiac amyloidosis.