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Endobronchial lipomatous hamartoma: an incidental finding in a patient with atrial fibrillation-a case report.

Schneider F, Winter H, Schwarz F, Niederhagen M, Arias-Herrera V, Martens E, Kääb S, Theiss H - Case Rep Med (2012)

Bottom Line: Introduction.Typically, they are located in the peripheral lung, while an endobronchial localisation is rare.Case Presentation.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine III, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany.

ABSTRACT
Introduction. Lung hamartomas are the most common benign tumors of the lung. Typically, they are located in the peripheral lung, while an endobronchial localisation is rare. Case Presentation. We present a case with the rare diagnosis of an endobronchial hamartoma as incidental finding in a 69-year-old male, caucasian patient with atrial fibrillation. At first admission, the patient's exertional dyspnea was caused by atrial fibrillation. Relapse of exertional dyspnea in the absence of arrhythmia was due to postobstructive pneumonia caused by an endobronchial hamartoma. Conclusion. Endobronchial tumors such as endobronchial lipoma or hamartoma should be considered as potential causes of exertional dyspnea and thus as differential diagnosis of atrial fibrillation. Although endobronchial hamartomas are benign, resection is recommended to prevent postobstructive lung damage.

No MeSH data available.


Related in: MedlinePlus

(a) On p.a. chest X-ray a prominent right hilum and a subtle increase in parenchymal density in the right infrahilar region was noted, a mass could not be clearly identified, however. (b) A noncontrast-enhanced CT scan of the chest revealed a mass within the bronchus intermedius (arrow) consisting mostly of fat with minimal inclusions of soft tissue density (Ao: Aorta ascendens; PT: pulmonary trunk; LA: left atrium). (c) Coronal slide in inverted thin-volume-rendering-technique of a contrast-enhanced CT scan performed for further workup demonstrated position and extent of the mass within the bronchus intermedius. (d) Virtual-bronchoscopy reconstruction from the nonenhanced CT scan displayed the mass within the proximal bronchus intermedius. The adjacent upper lobe bronchus was not affected. (e) Endobronchial round tumorous obstruction of the intermediate bronchus with a smooth surface with subtotal obstruction of the intermediate bronchus. (f) Recurent subtotal exclusion of the intermediate bronchus in the course of the disease and repetition of Argon laser therapy. (g) Incipient focal metaplasia of respiratory mucosa into squamous epithelium.
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fig1: (a) On p.a. chest X-ray a prominent right hilum and a subtle increase in parenchymal density in the right infrahilar region was noted, a mass could not be clearly identified, however. (b) A noncontrast-enhanced CT scan of the chest revealed a mass within the bronchus intermedius (arrow) consisting mostly of fat with minimal inclusions of soft tissue density (Ao: Aorta ascendens; PT: pulmonary trunk; LA: left atrium). (c) Coronal slide in inverted thin-volume-rendering-technique of a contrast-enhanced CT scan performed for further workup demonstrated position and extent of the mass within the bronchus intermedius. (d) Virtual-bronchoscopy reconstruction from the nonenhanced CT scan displayed the mass within the proximal bronchus intermedius. The adjacent upper lobe bronchus was not affected. (e) Endobronchial round tumorous obstruction of the intermediate bronchus with a smooth surface with subtotal obstruction of the intermediate bronchus. (f) Recurent subtotal exclusion of the intermediate bronchus in the course of the disease and repetition of Argon laser therapy. (g) Incipient focal metaplasia of respiratory mucosa into squamous epithelium.

Mentions: Electrocardiogram showed persistent atrial fibrillation (AF). Previously, the patient had undergone various therapies for AF including recurrent electric cardioversions and catheter ablation of the pulmonary veins. Thus, dyspnea was initially thought to be related to AF, and reisolation of the pulmonary veins was performed successfully. To screen for coronary artery disease prior to the administration of a class I antiarrhythmic drug as relapse prophylaxis, a noncontrast-enhanced, ECG-gated Multidetector CT (MDCT) scan of the heart was performed. Presence of relevant coronary calcium was excluded, but MDCT revealed a round mass of 1.9 cm diameter with fat equivalent CT density values in the right intermediate bronchus as an incidental finding (Figures 1(a)–1(d)). There was no contrast enhancement or popcorn calcification of the tumor. Lymph nodes were not enlarged. Since dyspnea improved after conversion into the sinus rhythm, the patient was discharged and referred for further workup of this finding on an outpatient basis.


Endobronchial lipomatous hamartoma: an incidental finding in a patient with atrial fibrillation-a case report.

Schneider F, Winter H, Schwarz F, Niederhagen M, Arias-Herrera V, Martens E, Kääb S, Theiss H - Case Rep Med (2012)

(a) On p.a. chest X-ray a prominent right hilum and a subtle increase in parenchymal density in the right infrahilar region was noted, a mass could not be clearly identified, however. (b) A noncontrast-enhanced CT scan of the chest revealed a mass within the bronchus intermedius (arrow) consisting mostly of fat with minimal inclusions of soft tissue density (Ao: Aorta ascendens; PT: pulmonary trunk; LA: left atrium). (c) Coronal slide in inverted thin-volume-rendering-technique of a contrast-enhanced CT scan performed for further workup demonstrated position and extent of the mass within the bronchus intermedius. (d) Virtual-bronchoscopy reconstruction from the nonenhanced CT scan displayed the mass within the proximal bronchus intermedius. The adjacent upper lobe bronchus was not affected. (e) Endobronchial round tumorous obstruction of the intermediate bronchus with a smooth surface with subtotal obstruction of the intermediate bronchus. (f) Recurent subtotal exclusion of the intermediate bronchus in the course of the disease and repetition of Argon laser therapy. (g) Incipient focal metaplasia of respiratory mucosa into squamous epithelium.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3295585&req=5

fig1: (a) On p.a. chest X-ray a prominent right hilum and a subtle increase in parenchymal density in the right infrahilar region was noted, a mass could not be clearly identified, however. (b) A noncontrast-enhanced CT scan of the chest revealed a mass within the bronchus intermedius (arrow) consisting mostly of fat with minimal inclusions of soft tissue density (Ao: Aorta ascendens; PT: pulmonary trunk; LA: left atrium). (c) Coronal slide in inverted thin-volume-rendering-technique of a contrast-enhanced CT scan performed for further workup demonstrated position and extent of the mass within the bronchus intermedius. (d) Virtual-bronchoscopy reconstruction from the nonenhanced CT scan displayed the mass within the proximal bronchus intermedius. The adjacent upper lobe bronchus was not affected. (e) Endobronchial round tumorous obstruction of the intermediate bronchus with a smooth surface with subtotal obstruction of the intermediate bronchus. (f) Recurent subtotal exclusion of the intermediate bronchus in the course of the disease and repetition of Argon laser therapy. (g) Incipient focal metaplasia of respiratory mucosa into squamous epithelium.
Mentions: Electrocardiogram showed persistent atrial fibrillation (AF). Previously, the patient had undergone various therapies for AF including recurrent electric cardioversions and catheter ablation of the pulmonary veins. Thus, dyspnea was initially thought to be related to AF, and reisolation of the pulmonary veins was performed successfully. To screen for coronary artery disease prior to the administration of a class I antiarrhythmic drug as relapse prophylaxis, a noncontrast-enhanced, ECG-gated Multidetector CT (MDCT) scan of the heart was performed. Presence of relevant coronary calcium was excluded, but MDCT revealed a round mass of 1.9 cm diameter with fat equivalent CT density values in the right intermediate bronchus as an incidental finding (Figures 1(a)–1(d)). There was no contrast enhancement or popcorn calcification of the tumor. Lymph nodes were not enlarged. Since dyspnea improved after conversion into the sinus rhythm, the patient was discharged and referred for further workup of this finding on an outpatient basis.

Bottom Line: Introduction.Typically, they are located in the peripheral lung, while an endobronchial localisation is rare.Case Presentation.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine III, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany.

ABSTRACT
Introduction. Lung hamartomas are the most common benign tumors of the lung. Typically, they are located in the peripheral lung, while an endobronchial localisation is rare. Case Presentation. We present a case with the rare diagnosis of an endobronchial hamartoma as incidental finding in a 69-year-old male, caucasian patient with atrial fibrillation. At first admission, the patient's exertional dyspnea was caused by atrial fibrillation. Relapse of exertional dyspnea in the absence of arrhythmia was due to postobstructive pneumonia caused by an endobronchial hamartoma. Conclusion. Endobronchial tumors such as endobronchial lipoma or hamartoma should be considered as potential causes of exertional dyspnea and thus as differential diagnosis of atrial fibrillation. Although endobronchial hamartomas are benign, resection is recommended to prevent postobstructive lung damage.

No MeSH data available.


Related in: MedlinePlus