SESSION TYPE: Airway Cases I
PRESENTED ON: Monday, October 22, 2012 at 01:45 PM - 03:00 PM
INTRODUCTION: Benign endobronchial tumors are rare causes of post obstructive pneumonia and asthma.
CASE PRESENTATION: A 38 year-old woman of Middle Eastern origin with past medical history of mild intermittent asthma presented to the pulmonary service for evaluation of recurrent pneumonias for 3 years. Patient reported recent fever, chills, mild non-pleuritic chest pain, and cough productive of copious amount of purulent sputum mostly in the morning. These symptoms worsened gradually over 10 days despite outpatient antibiotic treatment for presumed pneumonia. She had at least 6 episodes in the previous 3 years with similar presentations that were treated successfully with oral and intravenous antibiotics. In the last 2 episodes she had mild self-limited hemoptysis. In three of the previous episodes she had right lower and middle lobes infiltrates. She reports that her symptoms as well as the frequency of infections are getting gradually worse. Her PPD skin test and quantiferon test were negative. Her pulmonary function test was unremarkable. The patient is a lifetime non-smoker, married housewife has three healthy children and no sick contacts and no previous significant occupational exposure. She reported history of tuberculosis in her father’s side. A CT-scan of the chest was obtained which revealed an endobronchial mass in the right bronchus intermedius (figure 1a), bronchoscopy confirmed an obstructing endobronchial mass in that location (figure 1b). A snare was utilized to remove mass and was accomplished successfully with complete opening of the airway and removal of a pedunculated mass (figure 2). Patient remained without any pneumonia for more than 4 months, and reports significant improvement in her cough, sputum production as well as her asthma symptoms.
DISCUSSION: Bengin endobronchial tumors account to 1-5 % of all endobronchial tumors (1, 3). Chondromas are a subset of these benign tumors that affect the bronchial tree. In one case series of endobrochial masses only 2 out of the 248 masses removed with sleeve resection were chondromas this case series malignant low grade tumors were included (2). Removal of this benign tumor has been reported using a laser resection but not with a simple snare technique as in our case. (3).
CONCLUSIONS: Chondromas are benign endobronchial tumors that can pose diagnostic and therapeutic challenge. Removal with interventional bronchoscopic techniques should be given a priority over surgery.
1) Grover et al; Endobronchial Chondroma: A Rare Tumor Causing Complete Left Mainstem Bronchial Occlusion. Chest; 2003; 262s.
2) Lucchi M, et al; Sleeve and wedge parenchyma-sparing bronchial resections in low-grade neoplasms of the bronchial airway. General thoracic surgery:2007 Aug; 134 (2):373-337.
3) Benign tumors of the tracheobronchial tree:endoscopic characteristics and role of laser resection.Chest 1995;107:1744-51.
DISCLOSURE: The following authors have nothing to disclose: Berhanemeskel Nesketa, Saadah Alrajab, Adam Wellikoff, Timothy Gilmore
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