case_images: PMC10619460_01
case_images: Chest radiograph. Atelectasis is indicated by the covered right heart margin, the declivitous right lower lobe bronchus, and the triangular high-density shadow above the right diaphragm covering the right diaphragm and right lower lobe blood vessel. There is a fiber chord in the left lung.
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case_images: Chest radiograph revealed atelectasis of the right middle and lower lobes, and a fiber chord could be seen in the left lung (Figure 1).
case_images: CT scan of the chest (lung windows) showing lung windows before (A-C) and after treatment (D-F). (A-C) Lung windows showing irregular high-density thickening of the tracheal wall (A), both stem bronchi, lobar, and proximal segmental bronchi (B), leading to tracheobronchial luminal stenosis and atelectasis of the right middle and lower lobe (C). (D-F) Lung windows showing the relieved tracheobronchial wall thickening and luminal stenosis; there was bronchial inflation sign in atelectasis.
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case_images: A chest CT scan revealed irregular high-density thickening of the trachea wall, both stem bronchi, lobar, and proximal segmental bronchi, leading to tracheobronchial luminal stenosis and atelectasis of the right middle and lower lobe (Figures 2A-C and 3A-C). A chest CT scan demonstrated the partially relieved tracheobronchial wall thickening and luminal stenosis, with bronchial inflation signs in atelectasis (Figure 2D-F and 3D-F).
case_images: CT scan of the chest (soft tissue window) showing mediastinal windows before (A-C) and after treatment (D-F). (A-C) Soft tissue windows revealing the irregular thickening of tracheobronchial wall tissue accompanied by submucosal circumferential and granular calcification (A and B) and atelectatic lung tissue of the right middle and lower lobe with gathered bronchi outlined by the wall calcification (the bronchi are obstructed without air bronchogram sign) (C). (D-F) Soft tissue windows showing the relieved tracheobronchial wall thickening, luminal stenosis, and atelectasis of the right lower lobe; there was bronchial inflation sign in atelectasis.
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case_images: A chest CT scan revealed irregular high-density thickening of the trachea wall, both stem bronchi, lobar, and proximal segmental bronchi, leading to tracheobronchial luminal stenosis and atelectasis of the right middle and lower lobe (Figures 2A-C and 3A-C). A chest CT scan demonstrated the partially relieved tracheobronchial wall thickening and luminal stenosis, with bronchial inflation signs in atelectasis (Figure 2D-F and 3D-F).
case_images: Tracheobronchial images showing the bronchoscopy findings. The mucosa of the trachea and bilateral main bronchi is diffusely and circumferentially thickened, with multiple nodular protuberances and relatively narrow lumens. (A) Trachea. (B) Tracheal carina. (C) Proximal left main bronchus. (D) Distal left main bronchus. (E) Right main bronchus. (F) Right upper lobe bronchus. (G) Middle segment bronchus of right lung.
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case_images: A bronchoscopy revealed diffuse, circumferential and irregular thickening of the mucosa of the trachea and bilateral main bronchi, with multiple nodular protuberances and relatively narrow lumens (Figure 4).
case_images: Pathological findings of bronchial biopsies: (A) (HEx100), (B) (HEx400): Low and high magnification views showing abundant amorphous eosinophilic material depositing under the epithelium of bronchial mucosa. (C) (Congo red staining x400): Congo red stain highlight the dense accumulation of brick red amyloid material in bronchial mucosa; (D) (Congo red staining x400): Congo red stain typically shows apple-green birefringence in polarized light.
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case_images: The bronchial biopsies (Figure 5A-D) revealed massive amyloid deposits under the bronchial mucosa.