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Case Reports
. 2024 Oct 16;16(10):e71658.
doi: 10.7759/cureus.71658. eCollection 2024 Oct.

Tracheobronchial Amyloidosis Causing Left Lung Collapse: A Case Report

Rayhan Karimi  1 , Arun Adlakha  2 , Rob Thomas  3
Affiliations
Case Reports

Tracheobronchial Amyloidosis Causing Left Lung Collapse: A Case Report

Rayhan Karimi et al. Cureus. .

Abstract

Tracheobronchial amyloidosis is a rare condition characterized by the deposition of amyloid proteins in the trachea and bronchi, leading to significant respiratory symptoms such as chronic mucoid, cough, dyspnea, and recurrent respiratory infections. We present the case of a 61-year-old individual who developed tracheobronchial amyloidosis, which poses a diagnostic challenge due to its clinical and radiological resemblance to other pulmonary disorders, including chronic bronchitis. Histologically, tracheobronchial amyloidosis is characterized by the presence of amyloid deposits confirmed by Congo red staining, which shows apple-green birefringence under polarized light. Further confirmation can be obtained through electron microscopy, revealing non-branching fibrils. This report explores the clinical presentation, diagnostic challenges, and management of tracheobronchial amyloidosis. Therapeutic interventions may include bronchoscopic procedures to remove obstructive amyloid deposits and systemic treatments such as chemotherapy or immunotherapy to address the underlying amyloid process, aiming to improve patient outcomes and quality of life.

Keywords: amyloid mass; amyloid plaque; amyloidosis; bronchoscopy; chronic bronchitis; congo red stain; lung collapse; tracheobronchial.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Axial view of chest showing irregular thickening with calcification of the tracheobronchial airways (arrows).
Figure 2
Figure 2. Axial view of chest showing thickening, calcification, narrowing, and occlusion of the left bronchial tree (red arrow).
Also seen is airspace consolidation of the right middle lobe of lung (green arrow).
Figure 3
Figure 3. Congo red stained slide showing the red highlighted amyloid deposition beneath the mucosal surface (40x magnification).
Figure 4
Figure 4. Axial view of chest showing bilateral irregular thickened and calcified airways (red arrows).
Figure 5
Figure 5. Coronal view of chest showing bilateral irregular thickened and calcified airways (red arrows) with high-grade bronchial narrowing and occlusion of left bronchial tree (green arrow).
Also, volume loss and atelectasis of left lung and presence of scattered bronchial calcifications adjacent to the occluded airway were noted (black arrow).
Figure 6
Figure 6. Bronchoscope image showing a cluster of nodular mucosal lesions projecting into the lumen, at the level of the proximal trachea.
Figure 7
Figure 7. Bronchoscope image showing a thick mucus plug occluding the left main stem bronchus (red arrow).
Figure 8
Figure 8. Bronchoscope image showing a mucus plug occluding the left main stem bronchus (red arrow).
Figure 9
Figure 9. Post-suction bronchoscope image showing amyloid deposits in the distal anterior trachea and anterior carina.
Figure 10
Figure 10. Post-suction bronchoscope images of the left main stem bronchus and minor carina showing constrictive/occlusive disease (left 2 images with arrow) and mucosal nodular disease projecting into the lumen (right 2 images with arrow).
See this image and copyright information in PMC

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