Endobronchial hamartoma mimicking a bronchial foreign body and presenting with obstructive pneumonia: a case report

Endobronchial hamartoma is an uncommon entity and may radiologically resemble a bronchial foreign body because of frequent calcification and high attenuation on computed tomography. A male in his 50 s with diabetes mellitus presented with fever and was found to have a calcified 20-mm endobronchial lesion at the orifice of the left B8 segment, which had remained unchanged for 2 years. Newly developed distal atelectasis and pneumonia suggested bronchial obstruction. Because the patient had a history of recurrent aspiration and mobile teeth, a bronchial foreign body was strongly suspected. Bronchoscopy revealed an obstructing granuloma-like lesion but no visible foreign body. Despite antibiotic therapy, inflammation progressed with peripheral lung abscess formation, and a left lower lobectomy was performed. Histopathological examination demonstrated an endobronchial cartilaginous hamartoma without evidence of malignancy. The postoperative course was uneventful, with no recurrence during 6 years of follow-up. This case highlights that endobronchial hamartoma can closely mimic a long-standing bronchial foreign body clinically and radiologically and may cause refractory obstructive pneumonia. When bronchoscopic findings are inconclusive and infection is uncontrolled, early surgical intervention should be considered for definitive diagnosis and treatment.