Diagnosis:

Endobronchial Hamartoma
 

Radiologic Findings

Chest radiograph shows ill-defined increased opacity in left lower lung zone.  Pre-enhanced thin-section CT scan demonstrates consolidation in anteromedial basal segment of the left lower lobe with a 7-mm-sized, very low-density nodule in it.  Focal consolidation suggestive of segmental collapse was noted on lung window CT scan.  Suspicious several small low-density nodules were demonstrated within the consolidation on contrast-enhanced CT scan.  Adjacent pleural thickening and surrounding fibrotic band were associated with consolidation.  Bronchoscopy revealed endobronchial mass which totally occluded the bronchus of anteromedial basal segment. Radiologic Diagnosis 1. Pulmonary paragonimiasis 2. Chronic infectious procedure such as organizing pneumonia 3. Bronchogenic carcinoma 4. Endobronchial hamartoma Pathologic Diagnosis Endobronchial hamartoma At bronchoscopy, the lumen of the anteromedial basal segmental bronchus was totally obstructed by endobronchial mass of which surface was inflamed.

 

Brief Review

Hamartoma is the most common benign tumor of the lung. Most hamartomas are located peripherally in the lung parenchyma, near the pleural surface. But, it may occur near the hilum and 3-10% is presented as endobronchial mass. It is usually small in size and grows slowly. The peak incidence is in the sixth decade. Endobronchial hamartoma is a special form of the usual intrapulmonary hamartoma, which originates from a large bronchus, grows into the lumen and obstructs the bronchi. Therefore, most endobronchial tumors produce symptoms such as cough and fever due to bronchial obstruction. Hamartomas contain cartilage, fat, fibrous tissue, and epithelial component. Endobronchial lesion tends to have relatively more fat than the parenchymal lesion. Only rarely do they contain principally fatty tissue, in which case they are called lipomatous hamartomas or endobronchial lipomas. Main CT finding of endobronchial hamartoma is an endobronchial mass with or without obstructive pneumonia. In some cases containing fat or calcification, the specific diagnosis of hamartoma can be made.

 

References

1.      Ahn JM, Im JG, Seo JW, Han HS, Yoon HK, Kim WS, Yeon KM. Endobronchial hamartoma: CT findings in three patients. AJR 1994; 163:49-50 2.      Davis WK, Roberts LJR, Foster WLJR, Peyton RB, Halvorsen RJR. Computed tomographic diagnosis of an endobronchial hamartoma. Invest Radiol 1988; 23:941-944

 
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