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Communications to the Editor |

Workup Following Tissue Expectoration FREE TO VIEW

Raymond A. Dieter, Jr., MD; Glen Ellyn, IL
Author and Funding Information

Correspondence to: Raymond A. Dieter, Jr., MD, FCCP, 454 Pennsylvania Ave, Glen Ellyn, IL 60137; brdrad@aol.com



Chest. 2002;121(6):2084. doi:10.1378/chest.121.6.2084-a
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To the Editor:

The article by Kelly et al (February 1999)1 was of interest to us. The most common causes of expectoration are a result of infection with secondary bronchitis or pneumonia and tumor presence. Microscopic presence of carcinoma cells in sputum is common. It is uncommon, however, to see large portions of the tumor expectorated. Kelly et al1have reviewed the literature and discussed expectoration of endobronchial tumors. This subject has been of interest to us over the years as first evidenced by our report2 published in 1974 in American Family Physician. We noted in this article a number of patients with unusual expectoration, including bullets, gauze sponge, wax packs, broncholiths, metal “Weck” clips, shrapnel, and tumor casts of the bronchus. The patient mentioned in our article had a large poorly differentiated squamous cell carcinoma tumor cast of the bronchus expectorated postbronchoscopy. Since the time of that article in 1974, we have noted a number of patients with both primary and metastatic endobronchial lesions, who have expectorated bronchial casts or portions of the tumor, which on presentation to the laboratory for microscopic examination demonstrated the underlying etiology. We have found that most patients with significant hemoptysis, however, did not notice the presence of a tumor cast or mass; therefore, if such a specimen was present, it was not salvaged. We endorse further evaluation, endoscopic examinations, and radiographic review of any patient reporting expectoration of firm or hard tissue-like masses, even if the specimen has not been salvaged for gross or microscopic examination. A high index of suspicion will usually lead to definition of the underlying etiology even when radiographic findings appear normal.

Kelly, WF, Crawley, EA, Vick, DJ, et al (1999) Spontaneous partial expectoration of an endobronchial carcinoid.Chest115,595-598
 
Dieter, RA, Jr, Parker, P, Cornell, R, et al Unusual expectoration.Am Fam Physician1974;10,112-116
 

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References

Kelly, WF, Crawley, EA, Vick, DJ, et al (1999) Spontaneous partial expectoration of an endobronchial carcinoid.Chest115,595-598
 
Dieter, RA, Jr, Parker, P, Cornell, R, et al Unusual expectoration.Am Fam Physician1974;10,112-116
 
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