PMC6630020_01
HRCT of case 1 showed right main bronchi wall thickening, mimicking bronchial malignancy and mucous plugs.
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Subsequent CT Thorax revealed mild emphysematous changes, lung parenchymal cysts, and minor traction bronchiectasis consistent with obstructive airway in addition to bronchial wall thickening suspicious for malignancy [Fig. 1].
Bronchoscopy was done and reported as irregular proximal RMB, early changes in LMB highly suspicious of malignancy, normal cords and trachea.
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Bronchoscopy confirmed narrowing in the right main bronchus [Fig. 2].
(A) A low power view showed morphous material in keeping with amyloid deposition in the submucosa (B) Congo red staining on transbronchial right middle bronchus biopsy demonstrated apple green birefringence.
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Biopsy was uncomplicated confirmed tracheobronchial amyloid [Fig. 3].
Case 1 Severe obstructive picture, FVC 61%, FEV1 45%, DLCO normal at 84 %. FEV1/FVC ratio 0.58.
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FEV1 45% and DLCO 84% of predicted. FEV1/FVC ratio measured at 0.58) [Fig. 4].
PMC6630020_02
HRCT of case 2 showed bilateral apical scarring; several non-calcified lung nodules of different sizes were noted bilaterally. The largest is sub pleural indeterminate nodule/plaque of right upper zone.
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HRCT [Fig. 5] was performed and showed bilateral apical scarring; several non-calcified lung nodules of different sizes were noted bilaterally.
(A)sheets of esinophilic material in keeping with amyloid deposits, admixed with multinucleated osteoclast -like giant cells lymphocytes and mucosa cells.(B)Congo red staining positivity with apple green birefringence.
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The amorphous eosinophilic material stained positively with Congo red and apple green birefringence confirming a diagnosis of amyloidosis, and debunking malignancy [Fig. 6].
Case 2 PFT's, FEV1 of 0.64, FVC of 1.68 and DLCO of 105% predictive value. FEV1 and FVC ratio was noted at 0.38 which is consistent with a severe obstructive pattern.
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FEV1 22%, FVC of 45% and DLCO 105% of predicted. FEV1 and FVC ratio was noted at 0.38 which is consistent with a severe obstructive pattern [Fig. 7].