SHM Converge Scientific Abstract ePoster Gallery-Breathless Mystery: Unveiling Tracheal Amyloidosis as a Rare Cause of Respiratory Distress

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This case describes an 81-year-old man with diabetes and emphysema who presented with one week of cough and severe shortness of breath, requiring BiPAP for hypoxemia. CT angiography ruled out pulmonary embolism but revealed a large circumferential mass encasing the distal trachea and causing a long stenotic airway segment. Bronchoscopy with biopsy confirmed localized AL tracheobronchial amyloidosis through Congo red staining and classic apple-green birefringence under polarized light. Systemic amyloidosis was excluded with cardiac MRI and CT of the abdomen and pelvis.<br /><br />During his initial hospitalization, he underwent multiple endobronchial debulking and balloon dilation procedures and was discharged on room air. He was later readmitted with Aspergillus tracheitis superinfection, diagnosed by biopsy, bronchial washings, and PCR testing, and was treated with posaconazole. His prolonged course included additional bronchoscopies, stent placement, balloon dilations, and radiation therapy before he returned to Thailand for continued care.<br /><br />The report highlights that tracheobronchial amyloidosis is a rare cause of respiratory distress and may be mistaken for asthma, COPD, or pneumonia. Although localized disease can be managed with debulking and radiation, there is no definitive therapy, and recurrence and progression are common. Because airway compromise can be severe, accurate diagnosis with CT, bronchoscopy, and biopsy is essential, along with long-term multidisciplinary follow-up.

Asset Subtitle

Haley Torres

Meta Tag

Author List Ahmed Shabaik, Dana Toy, Haley Torres

Category Clinical Vignettes

Concept Tracheobronchial Amyloidosis

Concept Airway Obstruction

Concept Congo Red Staining

Concept Respiratory Distress

Concept Computed Tomography

Distinguished Non-Finalist

Presenter Organization University of California San Diego, School of Medicine

Presenting Author Haley Torres

Track Adult

Keywords

tracheobronchial amyloidosis

AL amyloidosis

airway obstruction

bronchoscopy

Congo red staining

apple-green birefringence

Aspergillus tracheitis

balloon dilation

endobronchial debulking

radiation therapy

Tracheobronchial Amyloidosis

Airway Obstruction

Congo Red Staining

Respiratory Distress

Computed Tomography