A 62-year-old man with a history of systemic Amyloid light-chain (AL) amyloidosis in prior haematological remission presented with progressive dyspnoea and non-productive cough. He denied haemoptysis, fever or weight loss. Examination was unremarkable apart from reduced bilateral breath sounds.
CT of the thorax demonstrated a bulky right hilar-mediastinal mass with mediastinal extension, vascular encasement and marked narrowing of the distal trachea and bilateral main bronchi (figure 1A), creating a radiological appearance highly suggestive of locally advanced lung cancer. Flexible bronchoscopy demonstrated a widened carina with significant extrinsic compression of both main bronchi but no visible endobronchial lesion or mucosal abnormality (figure 1B). The absence of an endobronchial lesion despite highly suspicious imaging prompted further tissue evaluation. Endobronchial ultrasound-guided cryobiopsy of a subcarinal lymph node was performed. Histopathological examination revealed amorphous eosinophilic deposits within the nodal tissue. Congo red staining demonstrated characteristic apple-green birefringence under polarised light, confirming…
