Bronchial Adenoma Clinical Presentation

Updated: Sep 19, 2019
  • Author: Charles W Van Way, III, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Presentation

History

Up to 60% of patients with bronchial adenomas have no symptoms. Asymptomatic disease is more likely if the adenoma is located peripherally as opposed to proximally. When present, symptoms are related to the presence and degree of endobronchial occlusion and the vascularity of the tumor. Hemoptysis occurs in 18%, recurrent infection or cough in 17%, dyspnea or wheezing in 2%, and carcinoid syndrome in 1%. As a result of these symptoms, prolonged treatment for another suspected condition (eg, pneumonia, asthma, COPD) frequently precedes the actual diagnosis.

Endobronchial symptoms

Manifestations of endobronchial involvement include the following:

  • Classic triad of cough, hemoptysis, and recurrent infection
  • Dyspnea
  • Wheezing and stridor
  • Sputum production
  • Pneumonia

Mediastinal involvement

Signs and symptoms of mediastinal involvement include the following:

  • Hoarseness due to recurrent laryngeal nerve involvement
  • Chylothorax due to thoracic duct involvement
  • Chest pain

Systemic

Systemic signs include the following:

  • Endocrinopathies
  • Unexplained weight loss
  • Low-grade temperature elevation
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Physical

Physical examination generally is unrevealing, but subtle findings may provide clues. In addition, the physical examination may help in finding other confounding disease processes.

Respiratory findings include upper airway obstruction, with stridor and wheezing, dyspnea, and hoarseness. 

Extrapulmonary manifestations are rare, but may include mechanical compressive and obstructive syndromes such as those seen in other thoracic malignancies and include the following:

  • Pancoast tumor - Superior sulcus tumor causing pain (eg, shoulder, forearm, arm, scapula), Horner syndrome, and atrophy of upper extremity musculature

  • Acute spinal cord compression – Paraplegia, sensory deficits, urinary retention/incontinence, and vertebral pain

  • Superior vena cava syndrome – Head congestion/fullness; headache; nasal congestion; dyspnea; cough; orthopnea; dilated veins in the upper extremity, neck, and face; upper extremity and facial edema; papilledema; facial cyanosis; and mental status changes

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