Reopening 8 Weeks Collapsed Lungs with Advanced
Bronchoscopy due to Bronchial Amyloidosis with
Refractory Bleeding

Yaniv Dotan; Maria Zaharan; Marina Levi-Potral; Hanna Ammury; Amichai Gutgold; Haitham Nasrallah; Abdah-Bortnyak Roxolyana; Asaf Miller

Case Report

Reopening 8 Weeks Collapsed Lungs with Advanced Bronchoscopy due to Bronchial Amyloidosis with Refractory Bleeding

Yaniv Dotan¹^a, Maria Zaharan¹^b*, Marina Levi-Potral¹, Hanna Ammury², Amichai Gutgold², Haitham Nasrallah³, Abdah-Bortnyak Roxolyana³ and Asaf Miller²

^1a,bPulmonary Institute, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel

²Department of Critical Care Medicine, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel

³Oncology Center, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel

^aThese authors contributed equally to this work.

^bThese authors contributed equally to this work.

Corresponding Author

Received Date: August 08, 2024; Published Date: August 20, 2024

Abstract

Amyloidosis is characterized by the deposition of misfolded proteins as amyloid fibrils in various tissues, including the lungs. Tracheobronchial amyloidosis, a rare form of pulmonary involvement, represents approximately 1% of amyloidosis cases. Symptoms include cough, wheezing, and hemoptysis.

We report a case of a 42-year-old female with a history of bronchial amyloidosis, previously managed conservatively. The patient presented with mild hemoptysis and was admitted for bronchoscopy, which revealed fresh blood and abnormal mucosa in the bronchi. During the procedure, the patient experienced sudden desaturation, leading to emergent intubation and subsequently to VV-ECMO due to refractory hypoxemia and complete atelectasis of the left lung. Despite extensive interventions including radiation therapy and multiple bronchoscopies, her condition deteriorated with persistent airway obstruction and bleeding.

After eight weeks of complete lung atelectasis, cryo-probe and argon plasma coagulation successfully managed the airway bleeding, allowing gradual lung re-inflation and weaning from mechanical ventilation and ECMO. However, the patient experienced significant complications, including digital ischemia requiring amputation, but ultimately recovered, with no further hemoptysis noted over 18 months.

This case highlights the potential for long-term lung re-inflation following complete atelectasis and underscores the importance of early intervention with radiation therapy for refractory tracheobronchial bleeding in bronchial amyloidosis. It illustrates the value of a multidisciplinary approach and innovative treatments such as cryo-probe and argon plasma coagulation. Continued research and awareness are essential to improve outcomes for patients with this rare condition.

Keywords:Tracheobronchial amyloidosis; Pulmonary amyloidosis; Bronchial bleeding; Lung atelectasis; VV-ECMO (Venous-Venous Extracorporeal Membrane Oxygenation); Cryo-Probe; Argon plasma coagulation; Radiation Therapy

Abbreviations:AL Amyloidosis-Amyloid light-chain (AL) amyloidosis; Venovenous (VV) extracorporeal membrane oxygenation (ECMO)

Article Details

Citation

Yaniv Dotan, Maria Zaharan*, Marina Levi-Potral, Hanna Ammury, Amichai Gutgold, Haitham Nasrallah, Abdah-Bortnyak Roxolyana and Asaf Miller. Reopening 8 Weeks Collapsed Lungs with Advanced Bronchoscopy due to Bronchial Amyloidosis with Refractory Bleeding. Archives in Respiratory & Pulmonary Medicine. 1(3): 2024. ARPM.MS.ID.000514.