Diffuse Tracheobronchial Amyloidosis

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Abstract
Eleven patients were referred to our institution for laser treatment of symptomatic localized tracheobronchial amyloidosis (LTBA) from 1983 to 1997. In 14 years we have treated approximately 2,110 new patients that received 4,624 laser sessions. Incidence of LTBA is 0.5% of all tracheobronchial lesions and 23% of all benign lesions. Symptoms at diagnosis were as follows: progressive dyspnea 54%, recurrent pneumonia 36%, stridor 18%, hoarseness 9%, dry cough 9%. Diffuse tracheobronchial infiltration and different degrees of stenosis were the most usual endoscopic finding. Extensive evaluation failed to prove systemic amyloidosis. All patients were treated with Nd-Yag laser. Profuse bleeding in 3 patients; upper respiratory insufficiency followed by orotracheal intubation for respiratory arrest and tracheotomy in 1 case; respiratory insufficiency requiring hospital admission in 1 case; and mild hemoptysis and aspiration pneumonia in 1 case were the complications associated with laser treatment. Two additional patients need tracheotomy (1 temporary and 1 permanent); stenting was used successfully in 2 cases, both complicated by granuloma formation. We have concluded that (1) progressive dyspnea was the most frequent finding before diagnosis; (2) tracheal or tracheobronchial intraluminal compromise causing concentric stenosis was the most frequent endoscopic finding; (3) laser treatment was associated with a significant number of complications; (4) LTBA caused significant morbidity in all patients; (5) and an acute, inflammatory phase followed after a variable number of years by a chronic, stable phase appears to be the course in this group of patients.

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