Endobronchial Tumor

Endobronchial Tumor

Jud W. Gurney, MD, FACR

Axial CECT shows a smooth round nodule in the right main bronchus image. The posterior wall is thickened image.

Coronal CECT reconstruction shows a nodule image in the right main bronchus in this patient with a carcinoid tumor.



  • Hemoptysis: Expectoration of blood from lower airways or lung

    • Massive hemoptysis: ≥ 600 mL blood/24 hours (1.5-5% episodes of hemoptysis)


General Features

  • Best diagnostic clue: Intraluminal lesion within airway lumen

  • Patient position/location: Can be located anywhere along visible airways (airway generations 1-10)

  • Size: Few mm to several cm in size

  • Morphology: Polypoid nodule nearly filling airway lumen, surrounded by crescent of air

CT Findings

  • Limited value in detecting endobronchial lesions < 2-3 mm in diameter

  • Endobronchial lesion, direct signs

    • Lesions may contain fat, calcium, or low-attenuation material from necrosis

    • Endobronchial lesions with contrast enhancement

      • Seen primarily with carcinoid tumors, less commonly mucoepidermoid carcinoma or leiomyoma

    • Endobronchial lesions containing calcification

      • Carcinoid (may have benign central nidus of calcification, 25% contain calcification)

      • Foreign body

      • Broncholiths

      • Tracheopathia osteochondroplastica

      • Hamartoma

      • Mucoepidermoid carcinoma

      • Amyloidoma

      • Leiomyoma (rare)

    • Endobronchial lesions containing fat

      • Hamartoma

      • Lipoma

    • CT cannot distinguish between mucosal and submucosal disease

    • Bronchial wall thickened, either diffuse or eccentric

    • Long axis of tumor may parallel course of airway or conform to branching pattern of airways

      • Seen with lipomas (soft malleable tumors) and mucoepidermoid tumors (lipidic growth pattern)

    • Endoluminal lesion typically polypoid

      • Attachment may be narrow or broad-based

      • Lumen eccentrically narrowed

      • Air crescent around lesion should suggest endobronchial lesion (also seen with intracavitary lesions)

    • Iceberg tumors have components both within and external to lumen

  • Endobronchial lesion, indirect signs

    • Faster growing tumors

      • Distal pneumonia

      • Distal atelectasis

    • Slower growing tumors

      • Distal mucoid impaction

      • Distal bronchiectasis

      • Distal air-trapping (least common)

  • Bronchus sign

    • Bronchus leading to peripheral nodule

    • Once identified, “roadmap” can be plotted to nodule for bronchoscopist

    • Triples yield (20% without to 60% with) from bronchoscopic biopsy

    • Identifiable in up to 90% of patients with peripheral solitary lesions

  • Workup hemoptysis

    • CT diagnostic yield 70%, bronchoscopy diagnostic yield 40%; combination diagnostic yield 93%

Sep 20, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on Endobronchial Tumor

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