INTRODUCTION: Endobronchial stromal polyps are rare benign tumors of the airways with very few case reports reported in the literature. We describe a case of a patient that presented with spontaneous pneumothorax and was discovered to have an endobronchial lesion that was totally obstructing the left upper lobe bronchus.
CASE PRESENTATION: Our patient was a 52 y/o male with previous history of emphysema that has had chronic cough for several months that presented to the hospital with sudden onset of chest pain and shortness of breath. He was discovered to have a large left-sided pneumothorax and a chest tube was placed with resolution of pneumothorax. A CT chest was done subsequent to resolution of pneumothorax to identify the etiology of the pneumothorax. There were no signs of any significant parenchymal lung disease other than a central polypoid endobronchial lesion in the LUL that was obliterating the entrance to LUL. There was no evidence of blebs in either lung. Given the possibility of Carcinoid, patient was referred to Interventional Pulmonary, and underwent rigid bronchoscopy where the lesion was removed by snare technique and sent for biopsy. The biopsy showed proliferation of an admixture of fibroconnective tissue and adipose tissue consistent with diagnosis of fibrous stromal polyp.
DISCUSSION: Fibrous Stromal Polyps or inflammatory polyps are very rare benign endobronchial lesions that have been seen in patients with chronic respiratory diseases or in patients that underwent mechanical ventilation. However, there have been no reported cases of a benign endobronchial stromal polyp contributing to a pneumothorax. We hypothesize that this could have happened by a ball valve effect where air cannot escape back because of the obstruction in the airways. Treatment of these lesions based on case reports varies widely and is dependent on the size of the lesion. Larger lesions are resected while smaller lesions have been reported to improve with steroids and in some cases even antibiotics.
CONCLUSIONS: Endobronchial stromal polyps can cause significant morbidity to patients and pneumothorax could be one of the complications of this not so benign endobronchial finding. Prompt recognition and biopsy is important in establishing a diagnosis.
Reference #1 Dincer et al. A Giant Endobronchial Stromal Polyp. The Annals of Thoracic Surgery. Volume 80, Issue 6, December 2005, Pages 2353-2356
Reference #2 Tedeschi et al. Endobronchial Polyp. Chest 1973; 63;110-112
Reference #3 Gamblin et al. Tracheal polyp. Ann Thorac Surg 2002;73:1286-1287
DISCLOSURE: The following authors have nothing to disclose: Bindu Akkanti, Fernando Santacruz, Pat Herlihy
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