Abstract Introduction Primary endobronchial lesions are rare in childhood, and the available literature is limited. These lesions may be either benign or malignant, making early recognition and treatment essential. Benign lesions encompass a broad spectrum, including hamartomas, hemangiomas, and inflammatory tumors. Importantly, other conditions such as endobronchial casts can mimic tumor-like lesions and should be considered in the differential diagnosis. Case Description A 15-year-old previously healthy male presented with a 4-month history of persistent cough, initially preceded by nasal congestion and rhinorrhea. He was treated with multiple antibiotics, systemic corticosteroids, inhaled corticosteroids, and albuterol without improvement. Due to persistent symptoms, a chest CT obtained during an ED visit revealed an endobronchial abnormality in the distal left mainstem bronchus. Symptoms had begun following participation in a prolonged baseball event. He was admitted for airway evaluation by pulmonology and ENT, and given concern for a potential malignant component, oncology was also consulted. Bronchoscopy revealed a large, white, avascular lesion in the left mainstem bronchus, which was partially debulked by ENT, as well as a smaller lesion of similar appearance in the right lower lobe. Black particles were noted in the left mainstem bronchus after debulking. Cultures were negative. Pathology demonstrated an eosinophil-rich, neutrophil-admixed inflammatory infiltrate, with no evidence of malignancy. Intermittent eosinophilia was also noted on CBC.The patient was managed with a prolonged course of corticosteroids and required repeat bronchoscopy for further debulking with a pediatric flexible bronchoscopy and cryoprobe. Although there was initial reduction in mass size, recurrence was observed after discontinuing steroids, necessitating re-initiation. He was maintained on airway clearance therapy with albuterol, 3% Hypertonic Saline and Acapella. Given concerns for a hyper eosinophilic state, he was started on mepolizumab, which led to resolution of the lesions. Discussion Endobronchial lesions often present with nonspecific symptoms, which may initially be mistaken for other conditions such as infection. While malignant tumors must be considered, benign and inflammatory causes are also possible causes. Although imaging is useful for evaluating lung anatomy and detecting lesions, bronchoscopy remains essential for both diagnosis and management, allowing biopsy and removal of the mass. Pathology is crucial to exclude malignancy and to characterize the lesion. Conclusion Inflammatory endobronchial lesions, although rare, can mimic neoplastic lesions. Bronchoscopy and tissue diagnosis can be critical for distinguishing benign from malignant lesions and for guiding therapy. This abstract is funded by: none
Rodriguez et al. (Fri,) studied this question.