Pulmonary Procedures |

Electromagnetic Navigational Bronchoscopy for the Diagnosis of Pulmonary Amyloidosis FREE TO VIEW

Anish Desai, MBBS; Guy Aristide, MD; Amishi Desai, MBBS; Linda Okonkwo, MBBS; Joseph Mathew, MBBS; Girish Balachandran Nair, MD
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Winthrop University Hospital, Mineola, NY

Chest. 2015;148(4_MeetingAbstracts):831A. doi:10.1378/chest.2280513
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SESSION TITLE: Procedures Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Electromagnetic navigational bronchoscopy (ENB) is a useful tool for the evaluation of pulmonary lesions inaccessible to conventional bronchoscopy. We present the first case of pulmonary amyloidosis diagnosed using ENB.

CASE PRESENTATION: A 57-year-old man with a history of obstructive sleep apnea and cholangiocarcinoma was referred to our pulmonary clinic for scant hemoptysis. He is an active smoker with a 60 pack-year history. Review of systems was positive for fatigue and dyspnea with moderate exertion. Physical examination revealed periorbital ecchymosis. Laboratory analysis including a vasculitis work-up was negative. A computed tomographic (CT) scan of the chest revealed a 1.5 cm nodule in the lingula and centrilobular emphysema. He was treated with levofloxacin for 7 days. A repeat CT chest performed after 2 months showed an increase in size of the previously noted nodule to 1.9 cm (figure-1). Subsequently, the patient underwent flexible bronchoscopy followed by ENB which revealed a normal tracheobronchial tree. Biopsy of the nodule was negative for malignancy, but showed an amorphous collection of cells which stained positive with Congo red, consistent with amyloidosis (figure-2). Urine immunofixation showed monoclonal lamda light chains with elavated levels of lamda chains in the serum (234.4 mg/L). The patient was then referred to an oncologist for further treatment recommendations.

DISCUSSION: Pulmonary amyloidosis without airway involvement is a rare entity, commonly presenting as a nodule or a mass (1). Diagnosis is usually established by CT-guided transthoracic needle aspiration (TTNA) or surgical resection, due to poor yield with conventional bronchoscopy. The risk of pneumothorax with TTNA is about 10-20% and it increases in the presence of co-existing emphysema (2). ENB combines CT-generated virtual bronchoscopy with electromagnetic tracking to enable passage of a steerable probe beyond the distal airways. ENB is more advantageous as the risk of pneumothorax is < 5% and surgical complications are avoided.

CONCLUSIONS: This case highlights the advantages of ENB as a safe and useful tool to aid in diagnosis of peripheral lung lesions. We expect the scope of ENB to widen exponentially once experience with this technique increases.

Reference #1: Cordier JF et al. Amyloidosis of the lower respiratory tract. Clinical and pathological features in a series of 21 patients. Chest 1986.

Reference #2: Chan S et al. Electromagnetic navigation bronchoscopy for the diagnosis of Aspergillus infection. Respirol Case Rep. 2014

DISCLOSURE: The following authors have nothing to disclose: Anish Desai, Guy Aristide, Amishi Desai, Linda Okonkwo, Joseph Mathew, Girish Balachandran Nair

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