PMC6010639_01
Chest X-ray (A) and CT (B and C) illustrating left lung volume loss with compensatory hyperinflation of the right lung. A left mediastinal mass encasing the distal trachea and left mainstem bronchus (solid arrows) results in complete collapse of the left lung (dashed arrows).
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Chest radiograph showed left lung volume loss with compensatory hyperinflation of the right lung, and computed tomography (CT) showed a left mediastinal mass encasing the distal trachea and left mainstem bronchus, with complete collapse of the left lung (Fig. 1).
Bronchoscopy Images. Panel A) Initial bronchoscopy at the distal trachea showing involvement of the trachea and near complete obstruction of the left mainstem bronchus by PIP with both endoluminal obstruction and extraluminal compression. Panel B) Repeat bronchoscopy after 3 months of steroid treatment showing restored patency of the left mainstem bronchus.
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Bronchoscopy revealed near complete obstruction of the left mainstem bronchus by a mass with mixed endoluminal obstruction and extraluminal compression (Fig. 2). Repeat bronchoscopy at that time also confirmed patency of the left mainstem bronchus (Fig. 2).
Panel A) The biopsy demonstrates a polypoid fragment of soft tissue lined by respiratory epithelium (Hemotoxylin and Eosin Stain, 10x magnification). Panel B) Higher power demonstrates bland spindle cells with chronic inflammatory infiltrates of predominantly lymphocytes and histiocytes (Hemotoxylin and Eosin Stain, 40x magnification). Panel C) The spindle cells are positive for smooth muscle actin and negative for desmin.
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Myofibroblast proliferation was confirmed with spindle cells staining positive for smooth muscle actin and caldesmon (Fig. 3).
Chest X-ray (A) and CT (B and C) after 3 months of steroid therapy demonstrating re-expansion of the left lung, decrease in size of the left mediastinal mass, patent left mainstem bronchus (arrow).
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Subsequent chest radiograph and CT scan after 3 months of therapy showed significant decrease in size of the left mediastinal mass, a patent left mainstem bronchus, and complete re-expansion of the left lung (Fig. 4).