Search

Primary tracheobronchial amyloidosis (TBA) is a rare disease characterized by extracellular focal or diffuse submucosal deposits of amyloid proteins. Various types of endobronchial lesions have been described in TBA when bronchoscopy is performed using white light. Narrow-band imaging bronchoscopy has been mainly employed for detecting preneoplastic and neoplastic endobronchial lesions as it provides more detailed images of the microvasculature reflective of an altered angiogenesis process. Here, we describe bronchoscopic findings with white light and narrow-band imaging in 2 patients presenting with central airway obstructive disease later confirmed as having primary TBA.

We present the case of a 33-year-old woman who was being treated for bronchial asthma for 4 years. A tracheal tumor was evident on a computed tomography of the thorax and removed with argon plasma coagulation. It was diagnosed as pleomorphic adenoma of the trachea. It is a rare tracheal tumor without definite treatment guidelines. Our endoscopic approach to this rare lesion is discussed.

Tracheal stenosis (TS) requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. We describe a case series at a tertiary care teaching hospital. Twenty patients with TS and/or subglottic stenosis were included. All underwent flexible bronchoscopy (FB). Spirometry (SP) was obtained in 8 patients, and helical computed tomography with three-dimensional reconstruction (HCT3D) was obtained in 11 patients. All cases were graded by each modality on a scale of 1 to 3, and the findings were correlated among modalities. Mean follow-up was 11.1 months (range: 3 to 47 mo). Postintubation injury was the most frequent cause of stenosis in 16 patients (80%). Mean stenosis grade±SD was 2.0±0.92 for SP, 2.3±0.86 for FB, and 2.54±0.68 for HCT3D. A significant correlation was found between HCT3D and FB (r=0.76, P<0.01). There was no correlation between SP and FB (r=0.46, P=0.2) or between SP and HCT3D (r=0.68, P=0.13). Treatment was conservative in 8 patients. Eighteen tracheal dilatation procedures were performed in 7 patients (mean: 2.5 dilatations/patient, range: 1 to 6; mean free time between dilatations 109.7±81 d, range: 6 to 210 d). Tracheoplasty was carried out in 7 patients, with tracheal anastomosis in 4 patients and thyroid-tracheal anastomosis in 3 patients. Tracheostomy was required in 1 patient with scleroma. Neither complications nor mortality related to FB was reported. HCT3D has a good correlation with FB. Tracheal dilatation is a viable option for patients who are not surgical candidates and for those with restenosis of tracheal anastomosis.