Peripheral pulmonary hamartoma with haemoptysis from the non-adjacent bronchus

An overview on the principles of management of haemoptysis

Haemoptysis is a frequently encountered presentation in thoracic surgery practice. Most of the patients present with chronic haemoptysis while 5% of them will present with life-threatening acute haemoptysis. Emergency surgery used to be the first-line management in acute life-threatening haemoptysis which resulted in significant morbidity and mortality. With advancements in interventional procedures, most of these acute presentations are now being managed conservatively by interventionists. In a country like India with a high incidence of tuberculosis and other infectious diseases of the lungs, haemoptysis is even more common. While interventional procedures help to tide over the crisis and earn valuable time to stabilise a haemorrhaging patient, surgical resection is the definitive management most of the time. This review will endeavour to establish the definition, aetiology, emergency, and definitive management of a patient who presents with haemoptysis.

Pulmonary Hamartomas: A Single-Center Analysis of 59 Cases

OBJECTIVE

This study investigated the clinical, radiological, and surgical treatment results of patients who underwent surgical treatment for pulmonary hamartomas.

MATERIALS AND METHODS

Fifty-nine consecutive patients who underwent surgical treatment for pulmonary hamartomas in our clinic between January 2001 and February 2021 were analyzed retrospectively.

RESULTS

Forty-three out of 59 (72.9%) of the cases were male and 16 (27.1%) were female. The average age was 52.0 ± 15.0 (between 5 years and 80 years). While pulmonary hamartoma was in the form of a solitary pulmonary nodule in 55 (93.2%) of the cases, there were multiple lesions in 4 (6.8%) cases. Simultaneous gastric adenocarcinoma was detected in 1 patient. One case had been operated on for Wilms tumor. Twenty-two (37.3%) of the cases were asymptomatic and were detected incidentally. Locations of pulmonary hamartomas were 18 (29.0%) in the left lower lobe, 16 (25.8%) in the right upper lobe, 12 (19.4%) in the right lower lobe, 9 (14.5%) in the left upper lobe, and 7 (11.3%) in the right middle lobe. The mean lesion diameter was 22.0 ± 9.5 mm (between 10 mm and 56 mm). Mild to moderate fluorodeoxyglucose (FDG) uptake was observed in 11 of 15 cases that were evaluated with positron emission tomography/computed tomography. Surgically, 44 (74.6%) patients underwent wedge resection, 13 (22.0%) patients underwent enucleation and two (3.4%) patients underwent lobectomy. Perioperative morbidity and mortality were not observed in any of the cases. The cases were followed up for an average of 40.6 ± 38.7 months (between 1 month and 151 months). No recurrence was observed in any of the cases during follow-up.

CONCLUSION

Pulmonary hamartomas are usually detected incidentally and as a solitary pulmonary nodule. Although radiological findings provide important information, a definitive diagnosis is usually made during surgery. Parenchyma-sparing surgery should be preferred in these cases whenever possible.

Pulmonary aspergilloma coexisting with hamartoma in post pulmonary tuberculosis: A case report

Introduction

Aspergillosis is a fungal disease caused by the Aspergillus fumigatus. Until now, the management of aspergilloma is still controversial, and there is no consensus among experts. Hamartoma is a benign tumor that can be found in the lung. We report a case of pulmonary aspergilloma coincidentally with hamartoma in pulmonary tuberculosis (TB) patients. Aspergilloma and hamartoma diagnoses are challenging because of various clinical symptoms.

Case report

A 46 years old man came to emergency unit with complaints shortness of breath, cough, and chest tightness. He also has a red-black blood streak and terrible odor sputum. He had a history of two episodes of pulmonary TB. Holistic physical and additional examinations were done. Patient was diagnosed with aspergillosis infection in post pulmonary TB. The patient was then undergoing surgery. From the pathology of lung tissue, we found hamartoma features. Antifungal, antibiotic, and supported therapy were given, and his condition improved after a month of hospitalization.

Conclusion

Pulmonary aspergilloma and hamartoma coincidence are rare diseases. Aspergilloma diagnosis is made based on clinical symptoms, radiological, and serological examination. Pulmonary hamartoma is generally asymptomatic. In this case, hamartoma was incidentally found in pathology examination. Prompt and precise diagnosis with good therapeutic management yield favorable outcomes.