Endobronchial Mass
Jeffrey P. Kanne, MD
DIFFERENTIAL DIAGNOSIS
Common
Non-Small Cell Lung Cancer
Small Cell Lung Cancer
Less Common
Carcinoid
Lung Metastases
Other Malignant Endobronchial Tumors
Aspiration
Rare but Important
Bronchial Atresia
Laryngeal Papillomatosis
Hamartoma
Broncholith
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Findings that suggest endobronchial lesion
Crescent of air around lesion
Lobar collapse or obstructive pneumonia
Recurrent pneumonia in same lobe
Most neoplasms malignant
Vast majority non-small cell lung carcinoma
CT has better sensitivity and specificity than chest radiography
CT can serve as guide for bronchoscopic biopsy
Helpful Clues for Common Diagnoses
Non-Small Cell Lung Cancer
Comprise more than 95% of malignant endobronchial tumors
Squamous cell most common cell type for endobronchial tumors
Often cause lobar or segmental atelectasis
Metastatic lymphadenopathy may extrinsically narrow bronchus
Obstructed airways may be dilated, impacted with secretions
Pulmonary artery and vein may be narrowed extrinsically by mass
Small Cell Lung Cancer
20% of all lung carcinomas
Usually peribronchial and invade into bronchial submucosa
May extend into bronchial lumen
Extensive metastatic lymphadenopathy common
Helpful Clues for Less Common Diagnoses
Carcinoid
1-2% of all pulmonary neoplasms
80-90% typical carcinoids (low grade)
10-20% atypical carcinoids (more aggressive)
Homogeneous endobronchial nodule on CT
30% contain chunky calcification (apparent on radiographs in only 5%)
Hypervascular on contrast-enhanced imaging
Obstructive pneumonitis may be present
Lymphadenopathy from metastases
Reactive lymphoid hyperplasia
Recurrent or chronic obstructive pneumonia
Lung Metastases
Less common than other primary sites
Breast, rectal, and renal carcinomas and melanoma most common
Can cause lobar or segmental atelectasis
Often enhance on CT (especially renal cell carcinoma and melanoma)
Other Malignant Endobronchial Tumors
Adenoid cystic carcinoma
Vast majority arise from trachea or main bronchi
Lobulated or polypoid endoluminal lesion on CT
Associated airway wall thickening
May present as diffuse, irregular tracheobronchial wall thickening
Mucoepidermoid carcinoma
Most arise in segmental bronchi
Polypoid endoluminal lesion, usually aligned with long axis of airway
May extend outside of airway wall (more aggressive tumors)
Other cell types rare
Aspiration
Foreign body
Most common in children (peak incidence between 1 and 2 years of age)
Food and broken teeth most frequent
Main bronchi most frequently affected
Pneumonia and atelectasis most common complications
Bronchiectasis may develop with prolonged retention of foreign body
Chest radiograph shows aspirated foreign body in < 20% of patients
Air-trapping of affected lobe(s) important feature
Paired inspiratory and expiratory radiographs useful
Atelectasis or pneumonia in affected lobe(s)
CT more sensitive
Helpful Clues for Rare Diagnoses
Bronchial Atresia
Rare congenital abnormality
Short segment obliteration of bronchus at or near origin
Left upper lobe apicoposterior segmental bronchus most common
Lung distal to obstruction developmentally normal, may be hyperinflated
Most patients asymptomatic
Radiograph
Hyperlucent area of lung in ˜ 90%
Hilar nodule or mass (bronchocele) in 80%
CT
Hyperinflated segment(s) with attenuated vessels
Mucoid impaction (bronchocele), finger in glove appearance
Laryngeal Papillomatosis
Human papilloma virus mediated papillomatosis of upper aerodigestive tract
May progress to involve trachea, bronchi, and lungs
Endoluminal nodules in trachea or bronchi
Lung nodules
Often multiple, may cavitate
Rapid enlargement: Suspect malignant degeneration into squamous cell carcinoma
Hamartoma
Comprise ˜ 70% of benign endobronchial neoplasms
Approximately 5% of pulmonary hamartomas endobronchial
∽ 50% contain foci of fat attenuation
May contain “popcorn” calcification
Broncholith
Endobronchial calcified or ossified material
Most caused by erosion of calcific material into airway, usually from adjacent calcified lymph node
Tuberculosis and histoplasmosis most common
Patients usually present with hemoptysis
Lithoptysis very uncommon; virtually diagnostic
Radiographs
Serial radiographs may show migration of calcified lesion
Atelectasis or obstructive pneumonitis
CT
May show bronchial distortion and better depict endoluminal calcium
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