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Durante la laringoscopia directa se objetiva una estenosis subglótica que dificulta la intubación orotraqueal. La tomografía axial computarizada (TAC) cervical muestra un engrosamiento subglótico inespecífico de aspecto seudonodular (19<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mm) en cara posterior de la pared traqueal proximal, que compromete parcialmente la vía aérea. Una broncoscopia flexible (<a class="elsevierStyleCrossRef" href="#sec0010">vídeo, material suplementario</a>) reveló una lesión amarillo-grisácea de aspecto granulomatoso con infiltración mucosa difusa y concéntrica que obliteraba el 30-40% de la luz traqueal (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>). La histología mostró depósitos de material amorfo que adoptaban una coloración rojiza tras ser expuestas a la tinción de rojo Congo; además de una birrefringencia verde manzana bajo la luz polarizada, compatible con amiloide. Ante la ausencia de sintomatología se desestimó cualquier intervención invasiva, realizando seguimiento ambulatorio.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">La amiloidosis en vía aérea superior es una enfermedad rara y poco frecuente, con una sintomatología muy inespecífica<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a>, y en ocasiones fácilmente confundible con otras entidades más comunes como el asma, la EPOC o el cáncer de pulmón<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a>. Es imprescindible una evaluación completa incluyendo TAC de alta resolución, que permita establecer el tipo de afectación pulmonar y la broncoscopia flexible con toma de biopsias para confirmar el diagnóstico anatomopatológico.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0025" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Anexo A" "titulo" => "Material suplementario" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 696 "Ancho" => 905 "Tamanyo" => 129730 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Amiloidosis traqueal.</p>" ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 7016163 "Video" => array:2 [ "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The lung in amyloidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Milani" 1 => "M. Basset" 2 => "F. Russo" 3 => "A. Foli" 4 => "G. Palladini" 5 => "G. Merlini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/16000617.0046-2017" "Revista" => array:5 [ "tituloSerie" => "Eur Respir Rev" "fecha" => "2017" "volumen" => "26" "paginaInicial" => "170046" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28877975" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. De Vega Sánchez" 1 => "C. Disdier Vicente" 2 => "G.AT Tracheobronchial amyloidosis as an incidental finding in a patient with lung cancer [Article in English, Spanish] Martínez García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2018.12.006" "Revista" => array:3 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2019" "itemHostRev" => array:3 [ "pii" => "S0168851014000566" "estado" => "S300" "issn" => "01688510" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005600000004/v3_202007180720/S0300289619302376/v3_202007180720/es/main.assets" "Apartado" => array:4 [ "identificador" => "21422" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images / Imágenes clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005600000004/v3_202007180720/S0300289619302376/v3_202007180720/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302376?idApp=UINPBA00003Z" ]
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