An unusual cause of a bronchopleural fistula

Article information

Korean J Intern Med. 2023;38(4):574-575

Publication date (electronic) : 2023 March 27

doi : https://doi.org/10.3904/kjim.2023.060

Dongyoon Keum¹, Mincheol Chae¹, Ilseon Hwang², Hyun Jung Kim³

¹Department of Thoracic and Cardiovascular Surgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea

²Department of Pathology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea

³Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea

Correspondence to: Hyun Jung Kim, M.D., Ph.D., Tel: +82-53-258-4519, E-mail: khj82827@kmu.ac.kr

Received 2023 February 5; Revised 2023 February 17; Accepted 2023 March 6.

A 70-year-old woman was admitted to the hospital with left pleuritic chest pain for 3 days. She complained of a cough, sputum, and chilling sensation but no dyspnea. She had no history of smoking or trauma. Pneumonia with a parapneumonic effusion and endobronchial nodule were evident on the chest computed tomography and flexible bronchoscopy (Fig. 1A, B). Despite receiving intravenous antibiotics and undergoing toilet bronchoscopy, the patient’s fever persisted. A pneumothorax was also detected, which recurred despite a closed thoracostomy (Fig. 1C). To address the obstruction of the left main bronchus, which was causing prolonged obstructive pneumonia and barotrauma, the patient underwent surgery. Thoracoscopically, the left lower lung was totally consolidated and purulent pus with a thickened pleura was noted (Fig. 2A). An endobronchial mass was removed through the bronchus (Fig. 2B). We performed a lobectomy of the left lower lung and the final histological diagnosis was endobronchial lipoma (Fig. 2C, D).

Figure 1

(A) Chest computed tomography (CT) revealed an endobronchial nodule with fat in the left main bronchus (arrow) and parapneumonic effusion on the left side. (B) Bronchoscopy revealed a well-circumscribed, firm, rounded endobronchial nodule in the left main bronchus. (C) Hydropneumothorax was evident on the left in the chest CT scan.

Figure 2

(A) Intraoperatively, an 1.0-cm-long bronchopleural fistula with pus discharge (arrow) was evident in the superior segment of the lower lobe. (B) A homogeneous and narrow-based yellowish mass was deeply embedded into the wall of the left main bronchus. (C) Adipose tissue was observed under the bronchial epithelium (Hematoxylin and Eosin [H&E], ×40). (D) Mature adipose tissue without any cellular atypia was noted (H&E, ×200).

Endobronchial lipomas are extremely rare and benign (0.1–0.5% of all lung tumors). Bronchoscopic intervention can be effective in preserving the lung function. However, despite the lipoma being benign, our patient required a lobectomy due to post-obstructive pneumonia intractable to medical treatment and irreversible lung damage. It is important to tailor the treatment according to the patient’s clinical condition.