047. Endobronchial hamartoma diagnosed incidentally

Background: Hamartoma, the most common benign lung tumor is often located peripherally in the lung parenchyma and rarely endobronchially: in this case it is diagnosed because of complications secondary to bronchial obstruction or because of chronic cough, hemoptysis and wheezing. We present a case of endobronchial hamartoma, discovered by chance.

Case report: We present the case of a 62-year-old man with a history of arterial hypertension, diabetes mellitus and anxiety disorder, who was hospitalized because of acute respiratory failure and persistent fever despite receiving cefuroxime. The radiological examination showed opacities of the right lower lobe which progressed to lung consolidation and right pleural effusion. The chest CT scan revealed peribronchial infiltration in the right lower lobe with concomitant parapneumonic effusion, as well as an endobronchial nodule in the left main bronchus. The characters of the pleural fluid after thoracocentesis were: pH =7.48, ADA =16 U/L, glu =143 gr/dL, total protein =3.54 gr/dL, albumin =2.16 gr/dL, 3,800 cells, 80% neutrophils. The cytological examination of the pleural fluid was negative for malignancy. The patient underwent bronchoscopy, which revealed a lesion of significant size in the left main bronchus before its division into upper and lower left bronchus, while no abnormal findings were found in the right bronchial tree. The cytological examination of bronchial brushing and bronchial washings were negative for malignancy, and the pathologic examination of the lesion revealed findings of hamartoma. The patient was treated with oxygen therapy and administration of moxifloxacin. Fever resolved within two days, respiratory failure was gradually restored, and radiographic findings resolved in ten days. The patient refused any intervention and is monitored regularly with a stable clinical and radiographic picture.

Conclusions: The reported case is rare because of the localization of endobronchial hamartoma, which was diagnosed incidentally, without being accompanied by characteristic clinical and radiological findings. The likelihood of hamartoma should be included in the differential diagnosis of endobronchial lesions.

Keywords: Hemartoma; broncoscopy; spirometry