C44-31 Hamartoma Gone Rogue a Curious Case of Atypical Presentation

Abstract Pulmonary hamartoma is the most common benign lung tumor, occurring in approximately 0.3% of the general population, more frequently in males and in the sixth decade of life. It accounts for 6-8% of solitary pulmonary nodules and 0.25% of all lung tumors. Most are asymptomatic and found incidentally on imaging; when symptomatic, patients may experience cough, hemoptysis, chest pain, or dyspnea. Pleural effusion is rare and typically not directly caused by hamartomas, so alternative causes should be considered when present. We present a 66-year-old male who was diagnosed with pulmonary hamartoma via bronchoscopy after presenting with pneumonia. A 66-year-old male with COPD, obstructive sleep apnea, hypertension, hyperlipidemia, and tobacco use was treated for pneumonia and found to have a right pleural effusion. CT chest revealed a right lower lobe mass-like lesion (presumed rounded atelectasis) with possible endobronchial filling defect. Subsequently, thoracentesis was completed, and pleural fluid revealed transudative with lymphocytic predominance, symptoms improved post-drainage. Bronchoscopy with biopsy identified a benign lesion, confirmed as endobronchial hamartoma after therapeutic removal. Repeat bronchoscopy showed no endobronchial reoccurrence.This case illustrates a rare presentation of pulmonary hamartoma as symptomatic pleural effusion with post obstructive pneumonia. The benign nature of hamartomas can lead to diagnostic challenges, especially when imaging suggests mass-like lesions or persistent atelectasis. PET imaging may show low or no uptake, underscoring the need for tissue diagnosis via bronchoscopy. Therapeutic bronchoscopy not only confirmed the diagnosis but also provided symptom relief. Greater awareness and reporting of such atypical presentations are needed to guide management and avoid unnecessary interventions. This abstract is funded by: none