B46-31 Benign But Breathless: When an Endobronchial Hamartoma Blocks the Airway

Abstract Introduction Pulmonary hamartomas are rare with incidence in the general population estimated to be 0.25% yet represent the most common benign tumor of the lung, accounting for about 75 percent of all benign pulmonary nodules. They are composed of a disorganized mixture of normal mesenchymal lung tissue including cartilage, adipose tissue, and smooth muscle. Men are disproportionately affected at a ratio of 2:1 to 4:1 male to female, classically in the sixth or seventh decade of life. Most of these lesions are located within the lung parenchyma, and patients are asymptomatic; as a result, they are often discovered incidentally. However, if the lesion is located within the bronchus; airway obstruction is common - resulting in symptoms such as cough, atelectasis, and recurrent infections. The potential for these benign lesions to masquerade as common pulmonary conditions underscores the importance of maintaining a broad differential diagnosis. Case Report We present a 76-year-old female, nonsmoker, who presented to her primary care physician for shortness of breath and coughing, worse at night, for 2 weeks. Empiric treatment for pneumonia with antibiotics and supportive care was ineffective. As follow-up, given her lack of improvement, a chest x-ray was ordered and demonstrated a 9.0 x 9.8 x 6.3 cm left upper lobe hazy opacity. Due to an interval size increase within 1-week on repeat chest x-ray, computed tomography with intravenous contrast was ordered. It illustrated a 1.4 cm endobronchial mass in the upper left bronchus with a tissue density consistent with macroscopic fat. Bronchoscopy showed a completely obstructing fungating lesion within the left upper lobe, with pathological evaluation of this mass revealing a fat predominant, benign, pulmonary hamartoma. Bronchoscope-guided resection was then performed (Figure 1), incorporating cryoablation and tumor debulking with ablation using argon plasma coagulation (APC), without complication. Discussion Endobronchial hamartomas, although rare and benign, may present with nonspecific symptoms that mimic malignancy or infection due to their obstructive mass effect within the airway. The primary factors associated with pulmonary hamartomas are male sex and advancing age, while smoking has not been established as a contributing factor. Our patient, an elderly female nonsmoker, represents an uncommon demographic for this condition yet reinforces the lack of association with smoking. Tissue biopsy is crucial to help distinguish these lesions from malignancy and can be safely resected using minimally invasive bronchoscope-guided techniques such as cryoablation and APC, as utilized in this case. This abstract is funded by: None