PMC10014982_01
(A-C) Endoscopic evaluation of the lesion in the right main stem bronchus.
Masses are occluding the end portion of the trachea and intermittent
occlusion of the left main stem bronchus during the respiratory cycle. (D,
E) Image is showing basal segments of the lower right lobe after resection
of the lesion. (F) Mucosa of the right intermediate bronchus with a
superficial laceration performed after the resection of the lesion in the
basal segments in the right lower lobe.
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Electrocautery and cryotherapy probes were used to achieve enucleation of the mass (Figure 1A-F).
A sequence of chest X-rays in posterior-anterior films. (A) Chest X-ray
performed immediately after the resection by bronchoscopy. It showed cardio
mediastinal structures with mild displacement to the right, orotracheal tube
positioned at the T4 and amputation of the right main stem bronchus. Also,
diffuse opacity in the right lung associated with atelectasis and alveolar
opacities, suggestive of a consolidative pattern in the left lower lobe.
Obliteration of the right costophrenic angle. Left costophrenic angle was
normal. (B) Chest X-ray control in intensive care unit showed multiple
pseudo-nodules scattered throughout in both lungs. A pulmonary consolidation
was observed in the left lower lobe plus bilateral pleural effusion. Cardiac
silhouette had a normal size. Proper endotracheal tube placement. Swan-Ganz
catheter in the left lower pulmonary artery. (C) Chest X-ray at day 4,
showing cardiac silhouette displacement toward the right hemithorax. Trachea
with an orotracheal tube in a good position, enteral feeding tube with its
distal end in the gastric chamber and Swan-Ganz catheter in the left lower
pulmonary artery. There are atelectasis involving the right lower lobe.
Reticular and nodular opacities were present in both lungs, and mild
infiltrates in the left lower lobe. (D) Improvement of pulmonary infiltrates
compared with previous chest X-ray. Volume loss of the right lung persisted.
(E) Chest X-ray showing a normal cardiac silhouette. Trachea with
displacement toward the right side with normal diameter. There are
persistent signs of volume loss of the right lung with ipsilateral
retraction of the trachea and mild reticular interstitials opacities without
a consolidative pattern. Interstitial opacities are present in the left
lower lobes. In addition, there is a discrete thickened peribronchovascular
interstitium without a consolidative pattern. (F) Six months after
discharge, a new X-ray was performed showing a mild volume loss of the right
lung with a better aspect from the previous chest X-ray. Right retro-cardiac
opacity probably due to atelectasis. There were no infiltrates, masses, or
pleural effusion.
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Chest X-ray showed the right lung with generalized opacities, plus diffuse left alveolar infiltrates, as shown in Figure 2A-C. The control chest X-ray reported a decrease in alveolar infiltrates and a mild opacity of the right base lung (Figure 2D, E). There are no pulmonary infiltrates, masses, or pleural effusion (Figure 2F).
(A, B) Mucosa lined by respiratory epithelium (arrow blue).
Hyaline cartilage (arrow red) interposed with adipose tissue inside the
chorion, without signs of malignancy. (C, D) Inside the chorion, there is a
niche of chondral tissue (arrow red) without increased cellularity,
binucleations, and mitosis. The epithelium lining without epithelial
dysplasia. (E) Transition between chondral and adipose tissue (arrow red).
Both of them are located in the chorion and have no malignancy signs. (F)
The chorion has ulceration areas (arrow red), and it is occupied by 2
mesenchymal components (chondral and adipose).
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These characteristics were compatible with endobronchial chondromesenchymal hamartoma (Figure 3A-F).
Control of bronchoscopy before discharge showing: (A) Normal appearance of
the vocal cord. (B) Distal trachea and carina are normal. (C, D) Success
resection of the lesion in the right intermediate bronchus wall, additional
showing thin wall and the divisions of the right inferior lobe. (E, F)
Residual lesion in the right lung's basal segments corresponding to the
sustentation site of the original resect mass. The residual lesion was
resected and showed a similar pathology from the tissue that was resected
previously.
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The architecture of the subsegmental bronchi of the right lower lobe was abnormal; they appear thinned, probably due to the presence of the slow-growing mass for a long time (Figure 4A-F).