SESSION TITLE: Bronchology/Interventional Procedures Cases I
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 26, 2014 at 10:45 AM - 12:00 PM
INTRODUCTION: Endobronchial lipoma is a rare cause of airway obstruction with variable presentation. There are only 130 cases reported worldwide. We present a case of hemoptysis from endobronchial lipoma which was resected with electrocautery snare.
CASE PRESENTATION: A 62 year old smoker with COPD and prior pulmonary embolism on Warfarin, presented with 3 days of productive cough, exertional dyspnea and low grade fever. He had diminished breath sounds at right base and temperature of 100.2 F. CXR showed right lower lobe consolidation. WBC count was 13,300/mm3. He was treated for community acquired pneumonia and COPD exacerbation. His condition improved but on the day of planned discharge, he developed mild hemoptysis that worsened over a period of hours. He had received Lovenox 120mg earlier that day for sub therapeutic INR of 1.8. Fresh frozen plasma was given. Flexible bronchosopy showed a large clot in the right main stem bronchus with partial obstruction of airway. The next day he underwent a rigid bronchoscopy with removal of a large organized blood clot from the right main stem bronchus. Further evaluation showed a non bleeding, white, shiny, smooth, pedunculated endobronchial tumor with some vascularity and ball valve effect in right lower lobe lateral basilar segment. Given concern for an aneurysm or granulomatous tumor, a contrast CT scan was obtained which was normal. Repeat rigid bronchoscopy was performed and the lesion was excised with electrocautery snare. Histopathologic analysis was consistent with endobronchial lipoma. Patient was discharged home in stable condition. CT scan of the chest after 3 months showed complete resolution of right lower lobe consolidation.
DISCUSSION: Endobronchial lipoma is very rare with overall incidence of 0.1 to 0.5% of all lung tumors. Smoking and obesity are risk factors but exact pathophysiology is unknown. Endobronchial lipoma could cause chronic obstruction and permanent damage to lung architecture. Hemoptysis is not a frequent manifestation and is reported in only 5% of cases with endobronchial lipoma. Hemoptysis is thought to result from post obstructive process. Bronchoscopic resection is considered the first line of treatment. There are only 5 other reported cases of tumor excision via electrocautery snare.
CONCLUSIONS: Endobroncial lipoma should be considered in the differential for benign appearing endobronchial tumors. Electrocatuery excision should be considered as first line of treatment for these tumors.
Reference #1: Ouadnouni Y et al.; Cases Journal 2009, 2:6377
DISCLOSURE: The following authors have nothing to disclose: Dhaval Raval, Hisashi Tsukada, Samaan Rafeq
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