Recurrent hemoptysis in a 62-year-old smoker
A 62-year-old male presented with recurrent hemoptysis for the past 1 year. Hemoptysis was intermittent, minimal and controlled with conservative treatment. There was no significant cough, breathlessness or wheezing. Medical history was not significant. He worked as a fireman and smoked 20–25 cigarettes per day over the last 40 years. Clinical examination was unremarkable. Being a chronic heavy smoker, pulmonary carcinoma was initially suspected and patient was admitted. Radiograph and computed tomography (CT) of the chest revealed no abnormality. Cardiac evaluation was negative. At flexible bronchoscopy, a reddish, round and smooth tumor mass was seen in the right lateral wall of the upper third of the trachea []. Multiple biopsies of the lesion were obtained without significant bleeding from biopsy site. Ultrasound neck showed a mass lesion (1.91 cm × 1.9 cm) adjacent to the trachea involving its wall and extending into its lumen on the right side []. A contrast enhanced computed tomography (CECT) showed moderate enhancement of the mass lesion []. Histological examination of bronchial biopsy confirmed the mass as papillary adenoma [Figures and ]. Patient was referred to cardiothoracic surgeon for further management. However, the patient decided to undergo surgery only when hemoptysis recurs and remained well during the follow-up period of 9 months.