TRACHEOBRONCHIAL MELANOSIS

Abstract

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: “Black bronchoscopy,” i.e., black pigmentation seen in the tracheobronchial tree, may be caused by a variety of conditions, some of which are uncommon or rare. We present a case of tracheobronchial melanosis, an uncommon cause of black bronchoscopy, in an elderly woman. CASE PRESENTATION: A 78-year-old female with past history of squamous cell carcinoma of the lung status post radiation treatment and chronic obstructive pulmonary disease was admitted for pneumonia. X-ray and computed tomography of the chest (Figure 1) were consistent with bilateral pneumonia. Flexible bronchoscopy (Figure 2) showed extrinsic compressions of the bilateral bronchial tree, non-inflamed bronchial mucosa, and numerous melanotic areas with indistinct margins distal to secondary and tertiary carinas, consistent with tracheobronchial melanosis. Bronchoalveolar lavage specimens were negative for malignant cells or bacterial, fungal, mycobacterial, or viral pathogens. DISCUSSION: The main differential diagnoses for black bronchoscopy include tracheobronchial melanosis, endobronchial pigment-producing infections, healed endobronchial tuberculosis, melanoma and other neoplasms, carbon, silica or silver exposure, burn injury, amiodarone, charcoal aspiration, and thermal ablation of endobronchial lesions. While not common, tracheobronchial melanosis is typically seen as an incidental finding on bronchoscopy. The lesions consist of areas of black pigmentation with indistinct margins, mostly adjacent to secondary and tertiary carinas [1]. Tracheobronchial melanosis is usually discovered in the absence of other mucosal abnormalities, and its clinical significance has not been determined. However, it is mostly considered to be a benign congenital variant resulting from abnormal production of melanin pigments in the tracheobronchial mucosa [2]. CONCLUSIONS: In addition to understanding common pathologic and normal bronchoscopy findings, it is important for pulmonologists, especially those in training, to be familiar with uncommon findings, normal variants, and lesions with unknown clinical significance, such as tracheobronchial melanosis. Reference #1: Tunsupon, P, Panchabhai TS, Khemasuwan D, Mehta A. Black bronchoscopy. CHEST 2013; 144 (5): 1696-1706. Reference #2: Pagliaccio L, Mehta AC. Endobronchial melanosis: occurrence and possible significance [abstract]. CHEST 1989; 96: 222S. DISCLOSURES: No relevant relationships by Elizabeth Nielsen, source=Web Response No relevant relationships by Thamer Sartawi, source=Web Response No relevant relationships by Keivan Shalileh, source=Web Response no disclosure on file for Rajagopal Sreedhar