Diagnosis 'surprise' - Obstructing Tracheal Lipoma (a rare tracheal tumor-aggravating cause in a moderate COPD)

摘要

Purpose: Introducing a patient with severe COPD and recurrent respiratory infections; bronchoscopic exam revealed a tracheal lipoma. Patient and method: 68-year-old patient, smoker, (124 PA), known with COPD for 10 years, noncompliant, has sustained inspiratory and expiratory dyspnea. Spirometry: severe mixed ventilation dysfunction. High-resolution CT: an approximately 17/17 mm endotracheal mass, non-iodophile, with the implantation base 5 mm above the carina, without invasion of the tracheal wall. Bronchoscopy: a pedicular tumor mass located on the posterior tracheal wall, intermittently obstructing the tracheal bifurcation area, predominantly the left main bronchus. Endoscopic intervention was performed through rigid bronchoscopy with jet ventilation. Histopathology: tracheal lipoma. Conclusions: The worsening of the obstructive syndrome in this patient was due to the association of two physiopatho-logical mechanisms: progressive obstruction in COPD and endotracheal obstruction caused by tracheal lipoma. The bronchoscopic intervention eliminated the obstruction, improving FEV1 by 32.9%.