Abstract Case 1 A 67 year old gentleman who presented with symptomatic hypoglycaemia was found to have an incidental finding of right lower lobe endobronchial lesion. He was a lifelong non-smoker. He had a CT thorax showing a partially obstructing lesion in the right lower lobe, as seen in Figure 1. He subsequently underwent bronchoscopy which identified 4 polypoid endobronchial blue lesions, the larger causing almost compete obstruction of the right lower lobe distal to the superior segment. He subsequently underwent a rigid bronchoscopy with EBUS ruling out atypical vasculature. Suction through a transbronchial needle did not identify blood , and thus the lesion was removed using an electrocautery snare. Case 2 A 78 year old female underwent a bronchoscopy in the investigation of lung nodules which were subsequently deemed benign on imaging. Bronchoscopy surprisingly detected a 15 mm blue endobronchial tumour at the orifice to the right upper lobe. She was a retired teacher with occupational exposure to chalk. After EBUS and trans-needle aspiration ruling out a vascular component, the tumour was biopsied. Diagnosis Histology from both tumours identified diffuse antracosilicotic pigment with extensive granulomatous and background fibrosis. Therefore the diagnosis in both patients was benign airway tumours secondary to endobronchial anthracosilicosis. Discussion Endobronchial anthracosilicosis is a form of mixed dust pneumoconiosis, defined as macroscopic black pigmentation of the bronchial mucosa secondary to carbon and silica dust exposure. The proposed mechanism is the inhalation of carbon particles and silica dust. Discoid not associated with raised mucosa are not uncommon However deposits mimicking airway tumoursThese 2 cases initially raised the possibility of a vascular endobronchial malignancy, based on radiologic and bronchoscopic findings. We could not find any other publication using a combination of EBUS and transbronchial neede aspiration to rule out vascularity.We plan to perform EDAX scanning of anthracosilicotic pigment to assess for calcium carbonate. Figure 1: 67 year old male with endobronchial blue tumours. This abstract is funded by: N/A
Azman et al. (Fri,) studied this question.