A 61-year-old male, nonsmoker, with a past medical history of ulcerative colitis, dyslipidemia, and exercise-induced asthma, presented to the clinic for evaluation of multiple-year history of chronic cough productive of white sputum with associated occasional dyspnea on exertion, nonresponsive to inhalers. Family history pertinent for a father with lung cancer at age 70. The patient had no identifiable acute or chronic toxigenic exposure. Vital signs, including SpO2, were within normal limits, and physical examination was unremarkable. Spirometry performed six months prior demonstrated normal FVC, FEV1, FEV1/FVC ratio, and DLCO. Posteroanterior and lateral chest X-ray demonstrated a thin band-like opacity overlying the cardiac contour suggesting atelectasis of the right middle lobe (Figure 1).
Noncontrast CT of the chest showed an endobronchial soft tissue mass at the origin of the right middle lobe bronchus with postobstructive right middle lobe collapse (Figures 2-4).
A flexible bronchoscopy was performed, showing an exophytic, sessile polypoid lesion attached to the medial wall of the right middle lobe origin causing a significant luminal occlusion (Figure 5).
Endobronchial biopsies were taken, with pathology reporting lipoid fragments of the respiratory mucosa and submucosal adipose tissue with mild inflammation and reactive changes. The patient underwent a second flexible bronchoscopy with snaring forceps for a second biopsy; complete removal of the lesion was performed with pathology reporting endobronchial myxoid spindle cell lipoma (Figure 6).
Postbronchoscopy chest X-ray demonstrated complete resolution of the right middle lobe collapse. On follow-up, the patient reported complete resolution of his chronic productive cough as well as the dyspnea negating need for further pulmonary function tests.