A 59-year-old ex-smoker man, presented with progressive dyspnoea and wheezing for several years, interpreted as asthma unresponsive to inhaled therapy. Chest CT (Fig. 1A and B) revealed extensively calcified lesion measuring 17mm×9.5mm at the left main bronchial bifurcation, partially obstructing the lumen, with air entrapment observed in the left lung during expiratory phase (Fig. 1C). First bronchoscopic examination showed a large lobulated and vascularized lesion with a firm consistency, on the superolateral wall of the left main bronchus (Fig. 1D), causing complete obstruction of the bronchial lumen. Bronchial repermeabilization was possible after endoscopic treatment using a diathermic loop and 1.7mm cryoprobe (Fig. 1E). Additional haemostatic control was obtained with tangential argon-plasma coagulation (APC) and Arndt endobronchial blocker placed prophylactically. Only a residual lesion remained at a b6 subdivision (Fig. 1F and G). Histology revealed chondroid hamartoma. Follow-up chest CT identified residual endobronchial lesion (Fig. 1H) measuring 7mm×5mm at the left b6 segment and therefore a second bronchoscopy was performed, 2 months after the initial procedure. The residual polypoid lesion (Fig. 1I) was resected with an electrocoagulation loop in combination with a cryoprobe and APC (Fig. 1J). Endobronchial follow-up at 3 months showed no recurrence of the hamartoma (Fig. 1K).

Fig. 1.

(A and B) Initial chest computed tomography revealing a lesion (red arrow) at the left main bronchial bifurcation; (C) air entrapment observed in the left lung during expiratory phase in chest computed tomography; (D) endoscopic view of the left main bronchus; (E) bronchial repermeabilization process using cryoablation and argon-plasma coagulation by flexible bronchoscopy; (F) endoscopic view of the left main bronchus after endoscopic resection; (G) endoscopic view inside left b6 segment showing a small remaining lesion (yellow arrow) at a b6 subdivision; (H) chest computed tomography follow-up, 1 month after endoscopic resection, identifying a residual endobronchial lesion (red arrow) at the left b6 segment; (I) endoscopic view of left b6 segment showing a growing lesion (yellow arrow), 2 months after endoscopic resection; (J) endoscopic view inside left b6 segment after the second endoscopic treatment; (K) endoscopic view of left b6 segment, 3 months after the first resection.

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Endobronchial types account for less than 10% of pulmonary hamartomas.1 Although most pulmonary hamartomas are asymptomatic and found incidentally, endobronchial forms often present with symptoms (persistent cough, wheezing or haemoptysis) and have a higher likelihood of airway obstruction and pneumonia.2 Differential diagnosis includes malignant tumours and foreign body aspiration. Endoscopic resection of endobronchial hamartomas may present as definitive treatment and is generally performed by rigid bronchoscopy.1 Nevertheless, in cases involving distal lesions, flexible bronchoscopy may be preferred over traditional rigid bronchoscopy, enabling further techniques such as loop, cryoprobe, APC and endobronchial blocking.1,3 Guidelines regarding endoscopic follow-up in these cases are insufficient in literature.