Correct!
2. Bronchoscopy
The patient underwent bronchoscopy and a lesion was found occluding the orifice of the left upper lobe bronchus (Figure 3).
Figure 3: Bronchoscopic image showing a lesion occluding the left upper lobe bronchus.
This lesion was biopsied and a diagnosis was established. The patient subsequently underwent surgical resection of the left upper lobe. She recovered uneventfully.
Diagnosis: Left upper lobe collapse resulting from mucoepidermoid carcinoma
Differential Diagnosis: The differential diagnosis of an endobronchial lesion is large, and includes mucous, primary and secondary malignant neoplasms, benign tumors, aspirated foreign bodies, post-inflammatory, infectious, or traumatic strictures, and inflammatory polyps. Proliferative lesions, such as amyloidosis, are a rare cause of endobronchial lesions. Among adult patients, primary malignancies, including bronchogenic carcinoma (particularly squamous cell malignancies) and carcinoid tumors are the most common etiologies for endobronchial obstruction. Less common primary airway malignancies include lymphoma and tumors of salivary origin, such as adenoid cystic carcinoma and mucoepidermoid carcinoma. Numerous benign tumors may present as endobronchial lesions, including papillomas, lipomas, hamartoma, leiomyoma, neurogenic tumors, and granular cell or glomus tumors (both of which may be malignant also).
Among children, tumors are a far less common cause of endobronchial obstruction and aspirated foreign bodies are typically the cause of endobronchial obstruction in the pediatric age group.
Numerous causes of long-segment airway strictures, such as Wegener’s granulomatosis, amyloidosis, and relapsing polychondritis, among other considerations, merit less consideration in this circumstance because such processes tend to be multifocal or diffuse, rather than focal and polypoid in morphology.
Given the patient’s young age, bronchogenic carcinoma would be unlikely, and some benign airway tumors, inflammatory myofibroblastic tumor, mucoepidermoid carcinoma, and carcinoid tumor would be the leading considerations.
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