Obstructing Endobronchial Lipoma Stefan W. Leichtle, MD, Vita McCabe, MD, and Ajay Gupta, MD Department of General Surgery and Cardiovascular and Thoracic Surgeons of Ann Arbor, Saint Joseph Mercy Health System, Ann Arbor, Michigan
Fig 1. FEATURE ARTICLES Fig 2.
A
73-year-old man with a history of long-term tobacco use presented with dyspnea and persistent cough. Computed tomography of the chest demonstrated complete atelectasis of the left lung with mediastinal shift
Fig 3.
toward the left. An endobronchial mass was identified within the left mainstem bronchus (Fig 1). Flexible bronchoscopy confirmed complete obstruction of the left mainstem caused by an endobronchial mass (Fig 2). Frozen section obtained from the mass demonstrated a lymphohistiocytic inflammatory reaction without evidence of malignancy. Initial attempts to excise the mass by rigid bronchoscopy were unsuccessful because of the firm texture of the mass. Subsequently, flexible bronchoscopy with snare electrocautery was used to successfully open the bronchus. The mass originated from the superior segment of the left lower lobe. Copious amounts of purulent sputum were present distal to the obstruction. Thorough bronchoalveolar lavage was performed. Final pathologic examination of the endobronchial mass revealed large fragments of mature adipose tissue with scattered chronic inflammation and overlying eroded bronchial mucosa. The histologic appearance was consistent with the rare finding of an endobronchial lipoma [1]. The patient underwent treatment with intravenous antibiotics for postobstruction pneumonia. Postoperatively, he was completely free of symptoms. Follow-up chest roentgenography 1 month after the procedure demonstrated bilateral clear lung fields (Fig 3).
Reference Address correspondence to Dr Gupta, Saint Joseph Mercy Health System, Cardiovascular and Thoracic Surgeons of Ann Arbor, 5325 Elliott Dr, Ste 102, Ypsilanti, MI 48197; e-mail: [email protected].
Ó 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc
1. Muraoka M, Oka T, Akamine S, et al. Endobronchial lipoma: review of 64 cases reported in Japan. Chest 2003;123: 293–6. Ann Thorac Surg 2014;97:714 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2013.06.095
Fig 1. FEATURE ARTICLES Fig 2.
A
73-year-old man with a history of long-term tobacco use presented with dyspnea and persistent cough. Computed tomography of the chest demonstrated complete atelectasis of the left lung with mediastinal shift
Fig 3.
toward the left. An endobronchial mass was identified within the left mainstem bronchus (Fig 1). Flexible bronchoscopy confirmed complete obstruction of the left mainstem caused by an endobronchial mass (Fig 2). Frozen section obtained from the mass demonstrated a lymphohistiocytic inflammatory reaction without evidence of malignancy. Initial attempts to excise the mass by rigid bronchoscopy were unsuccessful because of the firm texture of the mass. Subsequently, flexible bronchoscopy with snare electrocautery was used to successfully open the bronchus. The mass originated from the superior segment of the left lower lobe. Copious amounts of purulent sputum were present distal to the obstruction. Thorough bronchoalveolar lavage was performed. Final pathologic examination of the endobronchial mass revealed large fragments of mature adipose tissue with scattered chronic inflammation and overlying eroded bronchial mucosa. The histologic appearance was consistent with the rare finding of an endobronchial lipoma [1]. The patient underwent treatment with intravenous antibiotics for postobstruction pneumonia. Postoperatively, he was completely free of symptoms. Follow-up chest roentgenography 1 month after the procedure demonstrated bilateral clear lung fields (Fig 3).
Reference Address correspondence to Dr Gupta, Saint Joseph Mercy Health System, Cardiovascular and Thoracic Surgeons of Ann Arbor, 5325 Elliott Dr, Ste 102, Ypsilanti, MI 48197; e-mail: [email protected].
Ó 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc
1. Muraoka M, Oka T, Akamine S, et al. Endobronchial lipoma: review of 64 cases reported in Japan. Chest 2003;123: 293–6. Ann Thorac Surg 2014;97:714 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2013.06.095
