Unexpected diagnosis resulting from presentation with Chronic Obstructive Pulmonary Disease (COPD) exacerbation

Abstract

A bronchocele (bronchial mucocele) is a cystic formation caused by impacted mucoid secretion within the bronchial tree. Non-obstructive causes include bronchiectasis, cystic fibrosis, and asthma while obstructive causes include foreign bodies, benign strictures, congenital bronchial atresia, and in rare cases neoplasms. We describe the case of a 79-year-old male presented with increasing shortness of breath and pleuritic chest pain. He was treated for an infective exacerbation of chronic obstructive pulmonary disease (COPD). He was a current smoker with greater than a 40-year pack history. D-dimers were elevated at 1.49 and he underwent a computed tomography pulmonary angiogram that showed lobulated mass in the right lower lobe suggestive of a bronchocele. The patient underwent a bronchoscopy that demonstrated findings consistent carcinoid tumor. Transbronchial biopsies surprisingly revealed moderately differentiated squamous cell carcinoma. In rare cases, neoplasms have been associated with bronchoceles emphasising the importance of bronchoscopy (for direct visualisation) and biopsy in the workup. Keywords: Bronchocele; Bronchoscopy; Carcinoid tumour; Squamous cell carcinoma