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Weekly Chest CasesArchive of Old Cases

Case No : 431 Date 2006-01-30

  • Courtesy of Semin Chong, MD, Kyung Soo Lee, MD, Tae Sung Kim, / Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
  • Age/Sex 55 / M
  • Chief ComplaintDyspnea He had been treated for bronchial asthma.
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Tracheal Leiomyoma
Radiologic Findings
Chest radiograph shows soft tissue bulging contour in the right paratracheal area. Contrast-enhanced chest CT scans show a well-defined, lobulated 4.5-cm sized mass with endotracheal growth in the right posterolateral aspect of trachea, which demonstrates heterogeneous enhancement.

He underwent a segmental resection and end-to-end anastomosis of the trachea. On histopathologic examination, the resected specimen revealed a well-capsulated white tan lobulating tracheal mass with endotracheal growth. The final pathologic diagnosis was leiomyoma of the trachea with no evidence of malignancy.
Brief Review
Benign tumors of the trachea are rare, and reports of leiomyoma are even less common. Tracheal leiomyoma have been reported to account for approximately 1% of all tracheal tumors. Of the pulmonary leiomyomas reported, approximately 18% were found in the trachea, 34% in the bronchi and 48% in the parenchyma. Approximately 20 cases have been reported in Japanese and English literature. The average age of the reported cases, was 49.3 years old. Among the male patients, most cases were around 50 years old but among female patients, there was no standard age for this disease. Clinical symptoms included coughing, dyspnea, wheezing and bloody sputum. Ten patients (50%) had been misdiagnosed as having bronchial asthma. Conservative treatment for leiomyoma of the trachea should be selected depending on the location and size of the tumor, and careful follow-up should be done, keeping in mind both the possibility of recurring tumor and pneumonia. As in this case, most patients are initially diagnosed with asthma or chronic bronchitis, which may delay the correct diagnosis. Therefore, tracheal tumor should be considered in patients who present sudden onset of asthma, no response to medication, and change of symptoms according to posture.
References
1. Tamura M, Murata T, Kurumaya H, Ohta Y. Leiomyoma of an accessory tracheal bronchus. Ann Thorac Surg 2004:78:2163-2165.

2. Grillo HC, Mathisen J. Primary tracheal tumors: treatment and results. Ann Thorac Surg 1990; 49: 69?7.
Keywords
Airway, Benign tumor,

No. of Applicants : 52

▶ Correct Answer : 5/52,  9.6%
  • - CHRA, Annecy France Bing Fabrice
  • - Shahid Beheshti Hospital, Kashan, Iran Ebrahim Razi
  • - Annemasse, Polyclinique de Savoie, France Gay-Depassier
  • - Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
  • - China Medical University Hospital,Taiwan Jun-Jun Yeh
▶ Semi-Correct Answer : 3/52,  5.8%
  • - Radiologie Guiton, La Rochelle, France Denis Chabassiere
  • - Diskapi Yildirim Beyazit Hospital, Ankara, Turkey Meric Tuzun
  • - Hospital Ultra Care, Coimbatore, India Dababrata Das
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