A Case of Tracheal Hamartoma Resected with Loop Electrocautery

The authors report on the case of a 67-year-old man with longstanding breathlessness, which was eventually attributed to a fixed mass in the upper third of the trachea causing upper airway obstruction. The lesion was amenable to loop electrocautery resection via flexible bronchoscopy that led to prompt resolution of patient symptoms. Biopsy was consistent with tracheal hamartoma, an exceedingly rare benign tracheal tumor. All the cases of tracheal hamartomas in the literature to date, the application of electrocautery and other methods of interventional bronchoscopy for resection of selected tracheal tumors are discussed. 1. Introduction Primary tracheal tumors are rare in adults and usually malignant (80–90%). Reports regarding the histological distribution of the benign tracheal tumor are scarce, and little information is available about their natural history and behavior. The rarity of cases results in low levels of suspicion among physicians thus leading to substantial delay in correct diagnosis and treatment [1, 2]. 2. Case A 67-year-old exsmoker man presented with a 5-year history of progressive breathlessness on exertion and no other associated symptoms whatsoever. He had been empirically treated as for chronic obstructive lung disease in the past without any improvement. Flow-volume loop test revealed a variable extrathoracic airway obstruction (Figure 1). Chest X-ray was normal, but a thoracic CT scan revealed an 18 × 11 × 17？mm polypoid tumor in the upper third of the trachea with fat tissue density and no contrast uptake (Figure 2). The lung fields appeared normal. Figure 1: Flow-volume loop before (a) and after (b) the resection of the tracheal tumor. Figure 2: From left to right: axial, coronal, and sagittal CT views of the tumor located in the upper third of the trachea. The patient underwent flexible bronchoscopy under local anesthesia following an oral approach which demonstrated a white pendulated tumor covered with smooth mucosa attached with a narrow base of 2-3？mm to the right antero-lateral tracheal wall between the second and the third cartilaginous rings form the vocal cords. The lesion was obliterating the tracheal lumen by 80%. An electrocautery loop was passed through the bronchoscope, positioned around the base of the tumor, and tightened to gather the tissue at the point of its attachment to the tracheal wall. The tumor was completely resected by delivering electrocautery. Following resection, the tumor remained attached to the electrocautery loop, and it was removed with the simultaneous withdrawal of the bronchoscope, the