CASE REPORT   

Minerva Respiratory Medicine 2021 December;60(4):150-4

DOI: 10.23736/S2784-8477.21.01930-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Preoperative virtual bronchoscopy and fluoroscopic-guided transbronchial biopsy allowed amyloidosis diagnosis

Olivia FANUCCHI ¹ ✉, Alessandro PICCHI ¹, Roberta DORIA ², Alessandro RIBECHINI ¹

¹ Division of Thoracic Endoscopy, Department of Cardio Thoracic and Vascular Medicine, Cisanello University Hospital, Pisa, Italy; ² Division of Infective Disease, Department of Medical Care, Cisanello University Hospital, Pisa, Italy

The CT scan of a 75-year-old man, suffering from cough and hemoptysis, showed multiple nodular lesions of the lung. He had a history of prostatic cancer, treated and resolved with surgical therapy 3 years before. No infection nor atypical cell were observed in sputum examination, bronchial washing and brushing. The patient underwent two subsequent CT-guided biopsies, that did not uncover any malignancy. Positron Emission Tomography scan showed in increased FDG-uptake of the lung nodules. Thus he was referred to endoscopist for further evaluation. A careful evaluation of the case, with a three-dimensional imaging system, helped to identified the optimal path leading to the lesion and a bronchoscopic simulation was performed along the path, allowing to virtually visualize the procedure before the invasive exam. A fluoroscopy-guided bronchoscopic biopsy was performed, revealing a pulmonary amyloid deposit. As a rule, it is difficult to exclude malignancy or confirm benign disease in cases of truly benign lesions, particularly if the lesions are difficult to biopsy. Amyloidosis is one of such conditions and requires reliable diagnostic methods to avoid unnecessary surgical resection. From our experience, we consider fluoroscopy-guided bronchoscopic biopsy to be a safe and accurate.

KEY WORDS: Amyloidosis; Bronchoscopy; Three-dimensional imaging; Fluoroscopy; Biopsy; Case reports