A Case of Symptomatic Endobronchial Hamartoma Causing Right Upper Lobe (RUL) Atelectasis

ABSTRACT

Introduction: Pulmonary Hamartomas are the most common benign tumors of lungs. Hamartomas are usually asymptomatic and are incidentally diagnosed on chest imaging. Symptomatic cases usually involve endobronchial mucosa. We describe a case of a symptomatic patient who was noted to have a right upper lobe collapse by an endobronchial lesion. This lesion was confirmed to be a cartilaginous hamartoma and was definitively treated by electrosurgical by Argon plasma (APC). Description A 37 year old obese male active smoker presented to the ER for worsening Shortness of air (SOA) for two weeks. He had dry cough for similar duration without any fevers. On physical examination he was afebrile with normal vital signs but without hypoxia and otherwise normal physical examination. Labs revealed normal white cell count. A COVID test was negative. CT chest showed an endobronchial lesion obstructing the right upper lobe (RUL) with some internal fat density measuring at least 1.5cm causing complete collapse of RUL. No mediastinal or hilar adenopathy was noted. A flexible bronchoscopy showed a pedunculated smooth lesion arising from RUL bronchus anteriorly occluding the RUL bronchus. FNA of the lesion did not show any malignant cells. Using electrosurgery by APC the lesion was removed en bloc. A histopathology showed findings of cartilaginous hamartoma. A follow up Chest X-ray showed improvement in RUL atelectasis. Discussion: Pulmonary hamartomas are the most common benign pulmonary tumors and comprise 6% of solitary pulmonary nodules. Mostly detected on chest imaging as an incidental finding however CT chest has characteristic finding of pop corn shaped calcifications, fat density. Symptomatic cases are usually endobronchial and can be definitively treated with endoscopic techniques.