Low-temperature plasma radiofrequency ablation combined with multimodal bronchoscopic interventions for tracheobronchial amyloidosis-induced airway stenosis: a case report and literature review

Tracheobronchial amyloidosis (TBA) is a rare airway disorder characterized by abnormal deposition of amyloid protein in the submucosa and muscular layer of the tracheobronchial tree. Clinical manifestations are nonspecific, and the disease is frequently misdiagnosed as chronic obstructive pulmonary disease, bronchial asthma, or airway malignancy. No standardized diagnostic and treatment guidelines exist, and bronchoscopic interventions have become the preferred approach for relieving airway obstruction. We report a 56-year-old man with TBA presenting with a 12-year history of recurrent cough, sputum production, and dyspnea. Chest computed tomography (CT) revealed diffuse bronchial wall thickening with calcification and irregular luminal narrowing, with obstructive pneumonia and atelectasis in the right middle and lower lobes. Bronchoscopy demonstrated diffuse mucosal thickening with nodular hyperplasia and marked luminal stenosis. Congo red staining was positive with apple-green birefringence under polarized light, confirming localized TBA. The patient underwent three stages of multimodal bronchoscopic intervention over 12 months—comprising balloon dilatation, forceps debridement, diode laser ablation, low-temperature plasma radiofrequency ablation (LTP-RFA), and cryotherapy—to treat the primary, recurrent, and residual airway stenosis. Following serial treatments, the patient's symptoms improved significantly, with endoscopic and radiographic improvement. This case represents one of the few reports of LTP-RFA application in TBA. We review the recent literature on TBA treatment modalities and outcomes, providing a reference for individualized TBA management.