Tuberc Respir Dis.  2014 Jun;76(6):292-294.

Silicone Stent Placement for Primary Tracheal Amyloidosis Accompanied by Cartilage Destruction

• Ryu DH
• Eom JS
• Jeong HJ
• Kim JH
• Lee JE
• Jun JE
• Song DH
• Han J
• Kim H

Abstract

Primary tracheal amyloidosis (PTA) can lead to airway obstructions, and patients with severe PTA should undergo bronchoscopic interventions in order to maintain airway patency. Focal airway involvements with amyloidosis can only be treated with mechanical dilatation. However, the PTA with diffused airway involvements and concomitant cartilage destructions requires stent placement. Limited information regarding the usefulness of silicone stents in patients with PTA has been released. Therefore, we report a case of diffused PTA with tracheomalacia causing severe cartilage destruction, which is being successfully managed with bronchoscopic interventions and silicone stent placements.

Keyword

Amyloidosis; Airway Obstruction; Bronchoscopy; Stents

MeSH Terms

Airway Obstruction
Amyloidosis*
Bronchoscopy
Cartilage*
Dilatation
Humans
Silicones*
Stents*
Tracheomalacia
Silicones

Figure

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  Figure 1 Initial computed tomography (CT) and bronchoscopic findings with primary tracheal amyloidosis. (A) On the chest CT scan, the mid-trachea was narrowed to ~3 mm (black arrow) with irregular thickening of the wall and destructions of the tracheal cartilage (white arrows). (B) On bronchoscopy, diffused luminal narrowing secondary to submucosal infiltration was found from the level of thoracic inlet to the lower trachea.

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  Figure 2 Silicone stent implantation in a patient with primary tracheal amyloidosis. A silicone airway stent (outer diameter 12 mm, inner diameter 10 mm, length 50 mm) was inserted into the trachea to maintain airway patency.

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  Figure 3 Histological examinations of the bronchoscopic biopsy. (A) There is a homogenous pink amorphous material in the subepithelial region (H&E stain, ×100). (B) The subepithelial amorphous material shows reactivities with the amyloid P stain (amyloid P stain, ×100). (C) Congo Red staining reveals apple-green birefringence under the polarized light (Congo Red, ×200).

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