PMC10067637_01
Both lung views of plain chest computed tomography (CT) scan (A) and mediastinal view of contrast-enhanced CT scan (B) demonstrate the tracheal mass. (C) Initial bronchoscopic view of the mass occluding the lower trachea.
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F1
Thoracic non-contrast-enhanced computed tomography (CT) imaging revealed a cauliflower-like lesion of 4.9*4.6*4.6 mm in size affixed to the right wall of the lower trachea (Figure 1A), with an average density of 29 Hounsfield unit (HU). Contrast-enhanced CT imaging showed an inhomogeneous enhancement in the lesion with an average density of 200 HU (Figure 1B). Flexible bronchoscopy revealed a hyperemic, broad pedunculated tracheal neoplasm, arising from the right wall of the trachea in the lower one-third and projecting into its lumen, approximately 1 cm above the main carina with blood on the surface (Figure 1C).
Arteriography revealed a pathological artery originating from the bronchial artery (A) (blue arrow: tumor; red arrow: bronchial artery branch) that was selectively embolized (B). (C) Electrocautery loop snaring via flexible bronchoscopy; (D) posttreatment view of the same area.
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F2
Digital subtraction angiography (DSA) confirmed the presence of a feeding artery (Figure 2A). Post-embolization DSA revealed a marked reduction of the abnormal vascular blush and occlusion of the feeding artery and its branches (Figure 2B). In detail, the electrocautery snare was used in a blend mode at 40 W to cut and coagulate the base of the mass (Figure 2C), which was resected without significant bleeding, and tracheal patency was achieved (Figure 2D).
Histological examination of the resected specimen revealed capillary hemangioma (A) covered by the squamous epithelium and with fungal hyphae inside it (B).
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F3
Histological examination revealed numerous capillaries arranged in a lobular pattern, separated by an edematous fibrous stroma, accompanied by mild inflammatory changes (Figure 3A) with fungal hyphae inside it (Figure 3B), which was suggestive of polypoid LCH.