Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea, non-productive cough, and occasional hemoptysis. History significant for systemic AL amyloidosis. Symptoms are chronic and slowly progressive. No history of wheezing or orthopnea. Review of systems positive for fatigue and weight loss.
Clinical Examination Findings
Respiratory exam: Decreased breath sounds at the lung bases, bibasilar crackles, or localized wheezing if endobronchial involvement is present. Chest wall expansion may be reduced. Cardiac exam: Possible signs of restrictive cardiomyopathy (S3/S4 gallop, elevated JVP). Skin: Possible periorbital purpura or macroglossia.
Treatment Protocol
Management plan: 1. Multidisciplinary team referral (Hematology/Oncology for systemic AL treatment). 2. Symptomatic management with supplemental oxygen if hypoxemic. 3. Bronchoscopic evaluation for airway obstruction if indicated. 4. Avoidance of irritants. 5. Regular pulmonary function testing (PFTs) and high-resolution CT (HRCT) monitoring.