case_images: PMC10067637_01
case_images: Both lung views of plain chest computed tomography (CT) scan (A) and mediastinal view of contrast-enhanced CT scan (B) demonstrate the tracheal mass. (C) Initial bronchoscopic view of the mass occluding the lower trachea.
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case_images: F1
case_images: Thoracic non-contrast-enhanced computed tomography (CT) imaging revealed a cauliflower-like lesion of 4.9*4.6*4.6 mm in size affixed to the right wall of the lower trachea (Figure 1A), with an average density of 29 Hounsfield unit (HU). Contrast-enhanced CT imaging showed an inhomogeneous enhancement in the lesion with an average density of 200 HU (Figure 1B). Flexible bronchoscopy revealed a hyperemic, broad pedunculated tracheal neoplasm, arising from the right wall of the trachea in the lower one-third and projecting into its lumen, approximately 1 cm above the main carina with blood on the surface (Figure 1C).
case_images: Arteriography revealed a pathological artery originating from the bronchial artery (A) (blue arrow: tumor; red arrow: bronchial artery branch) that was selectively embolized (B). (C) Electrocautery loop snaring via flexible bronchoscopy; (D) posttreatment view of the same area.
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case_images: F2
case_images: Digital subtraction angiography (DSA) confirmed the presence of a feeding artery (Figure 2A). Post-embolization DSA revealed a marked reduction of the abnormal vascular blush and occlusion of the feeding artery and its branches (Figure 2B). In detail, the electrocautery snare was used in a blend mode at 40 W to cut and coagulate the base of the mass (Figure 2C), which was resected without significant bleeding, and tracheal patency was achieved (Figure 2D).
case_images: Histological examination of the resected specimen revealed capillary hemangioma (A) covered by the squamous epithelium and with fungal hyphae inside it (B).
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case_images: PMC10067637_01_fmed-10-1088815-g0003.jpg
case_images: F3
case_images: Histological examination revealed numerous capillaries arranged in a lobular pattern, separated by an edematous fibrous stroma, accompanied by mild inflammatory changes (Figure 3A) with fungal hyphae inside it (Figure 3B), which was suggestive of polypoid LCH.