Conversion to thoracotomy during VATS segmentectomy for treatment of symptomatic endobronchial hamartoma. (2018)

• Record Type: Journal Article
• Authors: Amore, Dario; Imitazione, Pasquale; Palma, Albina; Casazza, Dino; Scaramuzzi, Roberto; Di Natale, Davide; Molino, Antonio; Curcio, Carlo
• Is Part Of: International journal of surgery case reports. Volume 51(2018)
• Page Start: 272
• Page End: 274
• Publication Date: 2018
• Subjects: Endobronchial hamartoma -- Surgical resection -- Lung segmentectomy; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2018.09.006
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Endobronchial hamartomas are rare benign tumors. Surgical resection is recommended in patients with end stage lung injury or extra bronchial spread lesion. In presence of extra bronchial spread lesion, surgical team should keep in mind the possibility of potential vascular injury. Abstract: Introduction: Most hamartomas are located peripherally in the lung parenchyma and are rarely identified as an endobronchial lesion. Clinically patients with an endobronchial hamartoma are often symptomatic and may present with various symptoms including: fever, wheezing, hemoptysis and obstructive pneumonia. Case presentation: A 68-year-old man presented with complaints of fever and cough for 1 month. Chest X-ray revealed a right infrahilar density, which on chest CT was found to be a lesion obstructing the superior segmental bronchus of the right lower lobe and extending outside of the bronchus. A round rubbery mass obstructing the same segmental bronchus was noticed during bronchoscopy and endoscopic biopsy yielded a pathological diagnosis of hamartoma. Discussion: Bronchoscopy is most helpful in diagnosis and management of endobronchial hamartomas but if the lung distal to the obstruction is irreversibly damaged or imaging studies suggest that tumor extends outside of the bronchus, pulmonary segmentectomy, lobar resection or even pneumonectomy may be indicated. Conclusion: When a benign tumor of the lung, as endobronchial hamartoma, is located in a segmental bronchus and presents extrabronchial spread, we recommend to perform a parenchymal-sparing surgical resection. In this case surgical team, however, should keep in mind, due to difficult individual dissection of the segmental bronchovascular elements, the possibility of conversion from VATS (video-assisted thoracic surgery) to open thoracotomy.