Endobronchial Lesions in Children: Radiologic, Bronchoscopic, and Pathologic Correlation

Endobronchial lesions in children are uncommon and have various causes and symptoms can be vague and nonspecific, thus making early and accurate diagnosis challenging. Infants may only present with segmental hyperinflation, persistent lobar consolidation, or respiratory distress. Children with endobronchial obstruction usually present with wheezing, persistent cough, recurrent fever, and hemoptysis. Obstructive symptoms are seen when the mass occludes more than one-half of the endobronchial lumen. Unilateral lobar consolidation on chest radiographs is frequently diagnosed as pneumonia, although it could be secondary to a clinically occult endobronchial lesion. Foreign body aspiration may occur at any age but should be excluded if a child younger than 4 years presents with choking, a cough, or dyspnea. The radiolucent nature of many foreign bodies, including organic material and plastics, increases the complexity of diagnosis. Endobronchial tumors become more common in older children but are most often benign. Although they are less common than they are in adults, primary malignant salivary gland tumors and carcinoid tumors do occur in children, although most are benign or low grade with a good prognosis. Endobronchial abnormalities should be considered in the differential diagnosis in children with respiratory symptoms refractory to standard medical treatment. Bronchoscopy plays a vital role in assessing endobronchial lesions with direct visualization and biopsy. Tissue diagnosis assists in determining the optimal treatment plan. Benign and malignant endobronchial pathologic processes in children are reviewed and the multidisciplinary approach to these often challenging diagnoses is discussed. ^©RSNA, 2026 Supplemental material is available for this article.