Tracheal Hamartoma presenting with critical airway obstruction.
H. Kalsi*a (Dr), R. Thakrara (Dr), R. Khiroyaa (Dr), N. Navania (Dr), J. Georgea (Dr)
a University College London Hospitals NHS Foundation Trust, London, UNITED KINGDOM
Primary tracheal tumours are rare and account for <0.1% of all pulmonary tumours1. They are typically malignant and present with varying degrees of respiratory distress. Undiagnosed slow growing tumours may mimic respiratory diseases such as COPD, however harmful consequences may arise eventually resulting in critical airway obstruction.
A 68-year-old smoker with COPD presented with acute haemoptysis and stridor. He reported persistent wheeze and progressively worsening dyspnoea over the last year despite repeated courses of antibiotics, steroid, and inhaler therapy. He failed to respond to the same initial treatment in the Emergency Department, prompting a chest CT scan. This disclosed a tracheal mass causing near complete luminal obstruction, so he was immediately referred to our interventional bronchoscopy service. Rigid bronchoscopy demonstrated a large mobile soft tissue mass causing >80% luminal obstruction arising from a narrow base on the lower tracheal wall. Mechanical debulking was performed using rigid forceps and cryo-debridement; a 980nm semiconductor Laser was used to resect any residual tissue. Histology showed tumour fragments of mature adipose tissue, seromucinous glands and mucin filled cystically dilated duct-like structures, in keeping with a tracheal hamartoma. Following initial intervention, he made a rapid recovery with no further acute respiratory symptoms. Surveillance bronchoscopy and biopsy at 12 months showed no evidence of recurrence.
Hamartomas are the most common benign tumour of the lung, with 10-20% occurring endobronchially2. Tracheal hamartomas are extremely rare with few cases reported in the literature. Patients may present with non-specific respiratory symptoms preventing timely diagnosis and differential diagnosis should be considered, particularly when symptoms are refractory to medical treatment. Bronchoscopic intervention and ablation remains a safe appropriate therapy with low risk of tumour recurrence.
1. Primary tracheal tumours. Macchiarini 2006,PMID16389188, DOI:10.1016/S1470-2045(05)70541-6
2. Management of endobronchial hamartoma. Odile 2003, PMID12778997.
Disclosure of funding source(s): none