Pulmonary Amyloidoma Diagnosed With Robotic Bronchoscopy

Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Introduction: Amyloidosis is a disease characterized by the abnormal deposition of amyloid protein into organs and tissues. The more common form of the disease involves diffuse systemic deposition, and may cause dysfunction of the renal, cardiac, and neurologic systems. More rarely, amyloid deposition can be localized to a specific organ or location. Pulmonary amyloidoma results when localized deposition gives rise to a discernible nodule or mass in the lung tissue. The clinical course is variable and may be asymptomatic or result in destructive invasion of local structures. Case: The subject is a 75-year-old man with history of COPD with chronic hypoxemic respiratory failure from prior tobacco smoking as well as multiple pulmonary nodules. One nodule in the right middle lobe had been slowly growing over time and progressed to a mass based on size criteria. The patient had undergone multiple biopsies in the past which had not provided a definitive diagnosis. On his annual CT Chest for lung cancer screening, it was noted that the right middle lobe mass had further increased and now measured 3.8 x 1.9 cm. Due to his performance status and comorbidities, he was determined to be a poor candidate for surgical excision. After discussion, the decision was made to pursue repeat biopsy via robotic navigational bronchoscopy along with hilar and mediastinal lymph node sampling. Transbronchial biopsies of the mass demonstrated amorphous eosinophilic deposits on Congo Red staining, consistent with amyloidoma. The multidisciplinary tumor board recommended radiation therapy, and the patient completed the prescribed 12 sessions. He is currently scheduled for repeat CT Chest to reevaluate the right middle lobe mass post-treatment. Novelty/importance: Pulmonary amyloidoma without systemic involvement is an exceedingly rare condition, with fewer than 100 cases being published previously. Most cases are diagnosed via CT-guided biopsy or surgical resection, as bronchoscopy typically has low diagnostic yield. While electromagnetic navigational bronchoscopy has previously been reported as a modality to diagnose pulmonary amyloidosis, we were unable to find any previous reported instances of diagnosis with robotic bronchoscopy. This case demonstrates the utility of robotic bronchoscopy for diagnosis of peripheral lung nodules in patients poorly suited for CTguided biopsy or surgical resection.

Volume

209

Issue

Suppl

First Page

A4612

Comments

International Conference of the American Thoracic Society, May 17-22, 2024, San Diego, CA

DOI

10.1164/ajrccm-conference.2024.209.1_MeetingAbstracts.A4612

Link to Full Text

Share

COinS