CTICasesEndobronchial Mucous Gland Adenoma with Obstructive Atelectasis and Pneumothorax Ex Vacuo
Imaging findings
Chest radiographs showed classic findings of obstructive left upper lobe atelectasis: opacity at an elevated left hilum, elevation of the left hemidiaphragm, and an anteriorly displaced major fissure with adjacent opacity on the lateral view. A subtle sharp interface along the collapsed lobe corresponded on CT to a small locule of gas in the pleural space adjacent to the non-aerated, collapsed lung, a pneumothorax ex vacuo occurring in the setting of lobar collapse. Bronchoscopy identified an endobronchial lesion obstructing the lingular bronchus, which was biopsied and ablated; pathology showed a benign endobronchial lesion composed of dilated, mucin-filled glands and ducts, in the spectrum of a mucous gland adenoma.
Key takeaways
Pneumothorax ex vacuo is a benign, non-chest-tube-requiring collection of pleural gas that forms when increased negative pleural pressure from lobar collapse draws gas into the pleural space, and it resolves once the lung re-expands; this differs mechanistically from gas left behind after draining a pleural effusion in a trapped lung, and the two terms should not be used interchangeably. Benign endobronchial glandular or mesenchymal tumors, including mucous gland adenoma, are an important cause of obstructive atelectasis and should be considered alongside more common endobronchial neoplasms.
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