One Lung Wheezing due to Endobronchial Solitary Papilloma

A 55-year-old man was referred to our hospital due to intolerant severe short of breathing and persistent cough for two hours. He had similar attacks in the past two years which were treated with bronchodilators. Computed tomography revealed endobronchial mass, which was endoscopically resected by laser. Histology revealed benign squamous papilloma. In this paper we will deal with the various nonspecific clinical presentations, etiopathology, predisposing factors, and diagnosing tests of these benign tumors, especially the important role of computed tomography. 1. Case Presentation A 55-year-old man was referred to our hospital due to intolerant severe short of breathing and persistent cough for two hours. During the 2 years preceding presentation he suffered from less severe similar attacks, which were treated in a local clinic by bronchodilators inhalations with improvement. His past medical history revealed ischemic heart diseases and chronic obstructive airway disease. He used to smoke 30 cigarettes daily for the past 25 years. On physical examination, he had normal temperature of body 37°C, dyspnoea up to 40 breaths per minute, and, on auscultation to his lungs, perception of wheezing on the left hemithorax and normal sounds of breathing on the right one. He denied any aspiration of foreign body. Pulmonary function test (Figure 1) revealed FEV1—53%. Axial slice of chest computed tomography showed intrabronchial 0, 5？cm mass “polyp” in the left main bronchus (Figure 2 white arrow). This mass was endoscopically resected by laser without complications and histology revealed benign squamous papilloma. After the resection of the polyp, the patient did well as the symptoms regressed abruptly. Repeated pulmonary function test after resection of the polyp resulted in improvement of FEV1, which skyrocketed up to—76% (Figure 3). Because of technical reasons, HPV DNA was not tested. After one year of follow-up, the patient remains asymptomatic. Axial CT of chest (Figure 4) “lung window” showed that the bronchus still free of masses. Figure 1: Pulmonary function test showed FEV1—53% (red arrow). Figure 2: Axial CT of chest (lung window) at the level of left main pulmonary artery showing a pedunculated mass 0.5？cm in the left main bronchus (white arrow). Figure 3: Repeated pulmonary function test after resection of the polyp resulted in improvement showing FEV1—76%. Figure 4: After one-year follow-up, axial noncontrast CT of chest (lung window) showing that the bronchus is still free of masses. 2. Discussion Solitary endobronchial papillomas (SEP) are rare