Multimodal bronchoscopic management of endobronchial amyloidosis induced airway obstruction.

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Introduction: Endobronchial amyloidosis (EA) is a rare cause of airway obstruction, characterized by localized amyloid deposits in the tracheo-bronchial tree. We present a retrospective analysis of three cases of EA diagnosed at a tertiary care institute, each managed with different endoscopic debulking technique. Cases Case 1: A 49-year-old male presented with dry cough, exertional dyspnea, and fever. HRCT thorax showed right upper lobe consolidation with lymphadenopathy. Bronchoscopy revealed an obstructing endobronchial mass, reducing the RUL bronchial lumen by 70%. Debulking was performed using a Co-ablator and microdebrider, reducing the obstruction to 10%. Case 2: A 69-year-old female with dry cough, exertional dyspnea, stridor, and intermittent hemoptysis had an endobronchial lesion occluding 80% of the left main bronchus. Rigid bronchoscopy with cryoadhesion debulking reduced the obstruction to 20%, and a self-expanding metallic stent was placed to maintain patency. Case 3: A 62-year-old female with chronic cough and worsening dyspnea for three months had segmental atelectasis of the right middle lobe. Bronchoscopy revealed a friable, vascular lesion occluding 60% of the right middle lobe bronchus. The mass was removed endoscopically using laser debulking, and bleeding was controlled with argon plasma coagulation. Histopathology confirmed EA in all cases. Conclusion: This series highlights the role of rigid bronchoscopy in effectively managing EA, utilizing tailored debulking techniques to restore airway patency. Early diagnosis and individualized intervention are crucial for symptomatic relief and optimal patient outcomes.

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