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Abstract: This patient came to our hospital with “recurrent cough and sputum for many years with shortness of breath after activity”. The patient was diagnosed with pulmonary malformation tumor by combining the patient’s specific symptoms and fiberoptic bronchoscopy, and was treated with fiberoptic bronchoscopic intervention. After the operation, the patient’s cough and shortness of breath were significantly relieved, and no sign of tumor recurrence was seen by CT examination three months later.
Basic information】Male, 72 years old
Disease Type】Confined lung malformation tumor
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】February 2021
Treatment plan】Surgical treatment (fiberoptic bronchoscopic intervention)
Treatment Period】5 days after admission, regular follow-up
Effectiveness】Cough and shortness of breath were relieved significantly, and no tumor recurrence was seen in the 3-month postoperative follow-up.
I. Initial consultation
On a certain day in February 2021, the patient came to our department accompanied by his family. According to the family’s description, the patient started to have recurrent cough and sputum symptoms about 4 years ago, which were accompanied by shortness of breath after activity when severe. The patient had been diagnosed as having chronic obstructive pulmonary disease and chronic bronchitis at the local clinic several times, and after symptomatic and anti-inflammatory treatment, the patient’s symptoms were slightly relieved, but he did not recover completely, and no further treatment was given later. About half a month ago, the patient’s cough and sputum worsened after he went out and got winded, and his symptoms did not improve significantly after taking anti-inflammatory drugs on his own. After physical examination, the patient was found to have coarse breath sounds in both lungs, and dry rales could be heard in the right lung.
II. Treatment
After admission, a CT chest examination showed soft tissue masses in the right main bronchial wall and multiple pulmonary nodules in the right lung, while the left lung lesion was mild. Biopsy showed chronic inflammation in the local mucosa of the right main bronchus with epithelial hyperplasia.
After informing the patient’s family of his condition, the family decided to perform fiberoptic bronchoscopic intervention under local anesthesia because the patient was too old and did not want to undergo major surgical procedures. After surgery, the patient’s intrapulmonary mass was seen to be growing at the intersection of the right main bronchus and the right lower bronchus, and there were no obvious bleeding ulcerative lesions in the tracheal mucosa. The postoperative pathology showed that the surface of the patient’s mass was covered with ciliated columnar epithelium with a lobulated structure, and mature connective tissue was visible under the epithelium. The pathological diagnosis was limited pulmonary malformation tumor.
(CT: distinct round lesion with regular margins at the root of the right lung)
(CT: lesion without calcification with mild solid enhancement)
III. Treatment results
After the operation, the patient’s lesion was completely removed, and the symptoms of cough and shortness of breath were significantly relieved. 5 days after admission, the patient’s physical condition reached the discharge criteria, and all indicators tended to be normal, so he was discharged. Three months after the operation, no sign of tumor recurrence or metastasis was seen by CT examination, and the patient felt that his symptoms were in good condition.
IV. Notes
We are glad that the patient’s symptoms have been improved after treatment, but we still need to pay attention to some matters in daily life: 1.
1. It is recommended that patients should be reviewed once a month on time within the first six months after discharge, and if any uncomfortable symptoms occur during the follow-up period, they should immediately seek medical examination to avoid delaying the disease; after six months, if the disease is stable, it can be changed to review once every six months or a year according to the situation.
2. advise patients to eat more chicken, fish, eggs, milk, soy products and other foods after surgery to supplement nutrition, avoid high-fat, high-sugar and high-salt diets, and drink more water.
3.Since the lesion has caused some damage to the lung tissue, patients should pay attention to lung maintenance in the future, especially to stop smoking and drinking and other bad habits.
V. Personal insight
Pulmonary malformation tumors are usually thought to be caused by abnormal development of bronchopulmonary tissue, and the pathology often shows the coexistence of multiple bronchopulmonary tissues. Usually, fiberoptic bronchoscopic interventions have the advantages of simplicity, minimal trauma, and rapid postoperative recovery. If the preoperative biopsy biopsy suggests benign lesions or the chest CT shows benign morphological features, fiberoptic interventions can be performed under the guidance of specialized physicians, as in this case.