Endobronchial lipoma presenting as a fat-attenuation lesion causing left upper lobar bronchial obstruction: A case report

Endobronchial lipoma is an uncommon benign tumor of the tracheobronchial tree and may mimic more frequent causes of airway obstruction. We report a 61-year-old man who was admitted with intermittent cough and sputum for more than 1 year, aggravated for 1 week, with episodic breathing discomfort. He had been told 6 years earlier that he had left bronchial obstruction, but no systematic treatment or regular follow-up had been pursued. Chest computed tomography (CT), selected to directly evaluate the bronchial lumen because of the prior history of bronchial obstruction, showed localized obstruction of the left upper lobar bronchus with left upper lobe inflammatory change and atelectasis. An intraluminal lesion measuring 20.10 × 9.22 mm demonstrated macroscopic fat attenuation, with a mean attenuation of −99.12 HU. Bronchoscopic surgery was performed for a left upper airway lesion. Histopathology showed proliferative adipose tissue beneath the bronchial mucosa, consistent with bronchial lipoma. One-month follow-up CT showed restored left upper lobe aeration. The educational value of this case lies in the quantitative demonstration of macroscopic fat and the direct pre- and post-treatment CT comparison showing reversal of distal obstructive change.