We report the case of 31 years old female patient with endobronchial hamartoma diagnosed by CT scan after repeated episodes of chest pain and pyrosis. The first admission in March 2013, new mother for three months, the patient comes in pulmonology for the sudden appearance of stabbing chest pain, nocturnal cough and heartburn. A history of GERD treated with antacids as needed, and bronchial asthma onset after an episode of pneumonia arose during the first pregnancy occurred two years earlier.
Chest X-ray was performed and reported evidence of a prominent right hilum and a subtle increase in parenchymal density in the middle lung field but a mass could not be clearly identified (Fig. 1).
In June 2013, the patient returned to our structure for sudden onset of stabbing chest pain associated with dyspnea and fever. The laboratory tests revealed a mild neutrophilic leukocytosis associated with decreased hematocrit (35%) and slightly increased NSE.
A contrast-enhanced MD-CT scan of the chest was performed and revealed a beginning middle lobe pneumonia and presence of a mass within the bronchus intermedius consisting mostly of fat with minimal inclusions of soft tissue density (Fig. 2). Multiplanar reconstruction with axis parallel to the bronchus clearly showed that the lesion determined subtotal obstruction of the bronchus intermedius (Fig. 3).
The bronchial wall was very uneven and seemed to have a continuous solution on the outside, making its content not separable from the lesion (Fig. 4). Virtual-bronchoscopy reconstruction from the non-enhanced CT scan displayed the mass within the bronchus intermedius (Fig. 5).
Based on the findings and subsequent consultation between radiologist, pulmonologist and thoracic surgeon, the patient underwent wedge resection of the bronchus intermedius by thoracotomy. The macroscopic and microscopic sections of the lesion are shown in Figs. 6 and 7 respectively.
Non contrast CT shows the presence of a well demarcated endobronchial (right main bronchus) mass characterized by smooth margins and negative density (-89 HU).