Diagnostic value of using multiplanar reformation images: Case report for rare endotracheal hamartomas

Abstract

Rationale: Pulmonary hamartomas are the most common benign tumor of the lung. Two types of pathologically similar hamartomas exist based on their location. These tumors have a low incidence, are rarely reported and frequently misdiagnosed because of lack of familiarity and/or understanding concerning their imaging features.

Patient concerns: Seventeen patients received treatment between June 2007 and May 2013 and had complete medical records. All of them had different degrees of cough and expectoration. Other symptoms include fever (5 cases), hemoptysis (4 cases), chest pain (3 cases), shortness of breath (2 cases), and dyspnea (1 case).

Diagnoses: These patients all have pathologically confirmed, and informed the diagnosis of endobronchial hamartoma.

Interventions: Unenhanced and enhanced CT scans were performed using Toshiba Aquilion 64-slice and GE Lightspeed 64-slice CT scanners. The scan was performed from the superior thoracic aperture to the lateral costophrenic angle. The transaxial CT data was inserted into a Volume Wizard workstation to reconstruct images using MPR technique.

Outcomes: The relationship between the location of the tumor and bronchi was clearly displayed on the axial images in only 2 patients. In all 17 patients, reconstructed MPR images were able to display the tumor parallel to the long axis of bronchi, thus facilitating in tumor identification and positioning along the bronchial tree.

Lessons: MPR images are valuable tools in the diagnosis of endobronchial hamartomas. Chiefly, these reconstructions aid in the detection of intratumoral fat/calcification and clearly demonstrate the tumors relationship and effect with the adjacent bronchi.

Figure 1

(A–D) Example of an endobronchial hamartoma (arrows). Note the smooth surface and well-defined border, narrow base/stalk connection to the bronchial wall and absence of the adjacent bronchial wall thickening.

Figure 2

(A) Fat and/or calcified components within a hamartoma (arrows) (B) punctate calcification in the tumor focus, and (C) fat component in the tumor focus. Note the post-obstructive atelectasis (white arrow).

Figure 3

(A–D) Endobronchial hamartoma demonstrating patchy areas of enhancement after intravenous contrast administration (A and B from one case, and C and D from another case).

Figure 4

(A–D) Advantages of using MPR images (A and B are from one case, and C and D are from another case). (A) and (C) are axial CT images that demonstrate the hamartoma, but the axial images cannot clearly display the relationship between the location of the tumor focus and adjacent bronchus and the lack (or presence) of bronchial wall thickening. (B) and (D) are MPR images which are parallel to the bronchial long axis and clearly display the acute angles included between the tumor focus and adjacent bronchial wall. These images also help demonstrate lack of adjacent bronchial wall thickening or discontinuity, features that aid in the diagnosis of a benign hamartoma. MPR = multiplanar reformation.

Figure 5

(A, B) Example of a partially calcified hamartoma resulting in complete luminal narrowing and secondary post-obstructive atelectasis, specifically the right middle lobe (white arrow).

Figure 6

Pathological slide of the hamartoma, which consists of a large amount of cartilage and a small amount of bronchial gland and smooth muscle tissue (hematoxylin-eosin staining, ×25).