Iwanaga T, Hirai M, Kishikawa R, Yokota K, Ikeda T, Tsurutani H, Hirose T, Nishima S
Department of Respiratory Medicine, National Minami-Fukuoka Chest Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1996 Jan;34(1):90-5.
A 67-year-old man was first admitted to our hospital complaining of a productive cough, and repeated episodes of pneumonia in different sites. Physical examination revealed expiratory wheezing and airflow limitation wlas documented with lung function tests. A chest X-ray film showed patchy pneumonic infiltrates. Chest computed tomography revealed a marked thickening of the tracheal and bronchial wall with linear calcification. Fiberoptic bronchoscopy revealed a diffuse infiltrative process in the tracheobronchial tree, which uniformly reduced the bronchial lumen. Bronchial biopsy specimens showed amyloid deposits with focal calcification, which was confirmed by Congo red and Dylon staining. Extensive examinations including rectal biopsy were negatie for systemic amyloidosis. We suggest that diffuse tracheobronchial amyloidosis should be included in the differential diagnosis of repeated pulmonary infections with airflow obstruction.
一名67岁男性因咳嗽咳痰及反复发生不同部位的肺炎首次入住我院。体格检查发现呼气时哮鸣音，肺功能检查记录存在气流受限。胸部X线片显示斑片状肺炎浸润。胸部计算机断层扫描显示气管和支气管壁明显增厚并伴有线状钙化。纤维支气管镜检查显示气管支气管树弥漫性浸润性病变，导致支气管腔均匀变窄。支气管活检标本显示淀粉样沉积物伴有局灶性钙化，刚果红和Dylon染色证实了这一点。包括直肠活检在内的广泛检查未发现系统性淀粉样变性。我们建议弥漫性气管支气管淀粉样变性应纳入反复肺部感染伴气流阻塞的鉴别诊断。
