B47-05 An Unusual Cause of Chronic Cough and Recurrent Pneumonia: Endobronchial Lipoma

Abstract Introduction Chronic cough and recurrent upper respiratory tract infections are common presentations in primary care, and are often attributed to benign etiologies such as postnasal drip, viral infections, asthma or acid reflux. Endobronchial lipomas are rare benign tumours of the central airways that can mimic infectious or inflammatory conditions, leading to repeated misdiagnoses, and treatment delays. We present a case of a middle-aged woman whose recurrent “upper respiratory tract infection” and pneumonia-like episodes were ultimately attributed to an endobronchial lipoma. Case Presentation A 44-year-old woman with no history of smoking or chronic lung disease presented to our office with one year of recurrent episodes of cough, sore throat, and congestion, often diagnosed as pneumonia or upper respiratory tract infection. Serial chest radiographs alternated between unremarkable and showing left lower lobe airspace opacity, treated with multiple courses of antibiotics and steroids. Initially dry, her cough became productive over time. Despite transient improvement, symptoms recurred, prompting pulmonary referral. Baseline immunologic work-up was normal. Chest CT demonstrated a dense consolidation with air bronchograms in the left lower lobe and a well-defined endobronchial mass obstructing the left lower lobe bronchus. Diagnostic bronchoscopy revealed a large, soft, polypoid lesion completely occluding the left lower lobe bronchus, with post-obstructive purulent secretions. Biopsy confirmed mature adipose tissue consistent with a lipoma.Therapeutic bronchoscopy with electrocautery and hex snare resection was performed, successfully removing the mass in multiple fragments. Post-procedure cultures grew Haemophilus influenzae which was treated with antibiotics. Follow-up imaging at three months showed near-complete resolution of consolidation with only post-inflammatory scarring. A repeat bronchoscopy demonstrated complete resolution of the lesion with minimal mucosal scarring and a tiny, clinically insignificant distal stricture. Following resection of the lipoma, the patient reported resolution of her cough and no further respiratory infections, with a plan for annual surveillance chest CT. Discussion Endobronchial lipomas account for less than 0.5% of all lung tumours and can present insidiously with chronic cough or recurrent pneumonia, particularly involving the same lobe. Because chest radiographs may appear normal or nonspecific, diagnosis is often delayed until advanced imaging or bronchoscopy is performed. Early identification and bronchoscopic resection are curative, preventing irreversible parenchymal damage or recurrent infections. Conclusion Persistent or recurrent pneumonia localized to one lung region should prompt evaluation for airway obstruction. This case highlights the importance of considering benign central airway tumours such as endobronchial lipoma in the differential diagnosis of chronic cough and unilateral infiltrates. This abstract is funded by: None