Primary Localised Endobronchial Amyloidosis Mimicking Aspiration Pneumonia

A female in her 70s originally presented with a mechanical fall and a consolidation on a chest x-ray, thought to be secondary to aspiration. Failure to response to medical treatment prompted further investigations which revealed a calcific lesion obstructing the left lower lobe bronchus, histologically confirmed as endobronchial amyloidosis. Amyloidosis is a rare condition characterized by insoluble fibril protein deposition in various organs. Pulmonary amyloidosis can be a manifestation of systemic amyloid disease, or otherwise being isolated in nature. Tracheobronchial amyloidosis is a subtype of lung-related amyloidosis, and in fact being mostly not linked to a systemic form of disease. Removal of the lesion with rigid bronchoscopy led to an excellent recovery. Given that the lesion was focal and endobronchial, the most common manifestations would be complications related to collapse of the airway, including symptoms such as dyspnea or chronic cough and also episodes of recurrent pneumonias. Bronchoscopy and resection of the lesion is the main management of localised endobronchial amyloidosis unless systemic involvement or other complications are present.