A 44 year-old male former heavy smoker was referred to our hospital for an abnormal chest radiograph and cough. He reported productive cough, fevers and night sweats for three weeks. On review of systems he had an unintentional weight loss of 40 lbs over the previous four months. He never had a tuberculin skin test (TST) and denied tuberculosis contacts or wheezing. He was originally from Ecuador and had a history of right lower lobe pneumonia in the previous two years. A TST placed on admission was positive (20 mm). Decreased breath sounds on auscultation and dullness on percussion were appreciated at the right base. Blood tests revealed only mild leukocytosis (13,300 cells/uL) without bandemia. His basic metabolic panel and liver function panel results were unremarkable.
The patient's posteroanterior and lateral chest radiographs are shown in Fig. 1A-B. Chest CT images (axial and coronal views) are shown in Fig. 2A-B. Pulmonary function tests were normal. Flexible bronchoscopy showed a smooth round white polypoid lesion with wide base at the distal end of bronchus intermedius almost completely occluding the lumen (Fig. 3). White thick mucoid substance could be seen exuding from the right middle lobe bronchus. Our patient underwent bilobectomy and a biopsy of the polypoid lesion is shown in Fig. 4A-B. The diagnosis of an endobronchial leiomyoma causing complete obstruction of bronchus intermedius was made.
Chest CT scan reveals an endobronchial lesion (asterisk) in the bronchus intermedius with complete atelectasis of right lower lobe and a small pleural effusion. B, Coronal lung window.