Allergy and Airway |

A Rare Cause of Recurrrent Pneumonia in a 91-Year-Old Woman FREE TO VIEW

Abhishek Kumar, MBBS; Arjun Mohan, MBBS; Prerna Kumar, MBBS; Philippe Jaoude, MD
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SUNY Buffalo, Buffalo, NY

Chest. 2013;144(4_MeetingAbstracts):3A. doi:10.1378/chest.1702047
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SESSION TITLE: Airway Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Hamartomas are the most common non-malignant lung tumors, but their endobronchial occurance is rare. They are often described as solitary “coin lesion” on chest imaging. We report the oldest case known in literature with a new diagnosis of a pair of endobronchial hamartoma in the same location.

CASE PRESENTATION: A 91 y old woman presented with altered mentation, dyspnea and hypoxia, eventually requiring intubation and admission to ICU. Notably, she had recurrent admissions for pneumonia over the last year. On the day of presentation, nursing home records documented a witnessed aspiration. After four days of antibiotics, fever and leukocytosis subsided but left lower lobe density persisted despite chest percussion and aggressive suctioning. CT chest showed collapse of the posterior segment of left lower lobe, with obliteration of the airway. No definite mass was reported. Subsequent flexible bronchoscopy revealed patent lumen till the bifurcation of left posterior and lateral basal segment, where the mucosa appeared inflamed. Inability to pass bronchoscope distally prompted use of the cytobrush, which hit a firm obstruction. Consequent use of forceps to remove or biopsy the obstructing lesion pulled two smooth whitish pedunculated lesions in the proximal left lower lobe bronchus. Multiple biopsies were taken, but removal of the lesion not attempted due to its indeterminate origin or etiology. Biopsies revealed fragments of inflamed bronchial tissue, pure cartilage and fibrinous material, suggestive of endobronchial chondroid hamartoma. Removal of the hamartoma was discussed with family, but not pursued due to patient’s underlying dementia and minimal baseline functionality.

DISCUSSION: Pulmonary hamartomas range in incidence from 0.025% to 0.34%; only 1.4% are endobronchial. To date, our patient is the oldest reported case, reiterating its slow-growing and benign nature. Hamartomas are almost always solitary, but we found two adjacent well-defined ones, which is very rare. The two most common histologic patterns described were that of chondroid and lipoid hamartoma (37.2% and 30.2% of cases, respectively). Endobronchial hamartomas present with recurrent pneumonia, hemoptysis, cough, dyspnea and wheezing in over 80% of the cases. Procedures like rigid bronchoscopy with/without laser, fiberoptic bronchoscopy with snare/forceps removal and surgery have yielded permanent cures with rare recurrence.

CONCLUSIONS: 1. Recurrent pneumonia with persistent segmental collapse should prompt early bronchoscopic evaluation. 2. Endobronchial hamartomas are frequently symptomatic, but can be definitively cured, avoiding complications and excess cost to healthcare.

Reference #1: Gjevre et al. Pulmonary hamartomas. Mayo Clin Proc 1996; 71:14-20

Reference #2: Cosío et al. Endobronchial hamartoma. Chest. 2002 Jul;122(1):202-5.

DISCLOSURE: The following authors have nothing to disclose: Abhishek Kumar, Arjun Mohan, Prerna Kumar, Philippe Jaoude

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