Tracheobronchial tumor cast formation and pneumothorax

A 34-year-old white man was admitted to the hospital for progressive respir atory difficulty, recurrent left pneumothorax, and a diagnosis of aplastic left lung. Further evaluation, including bronchoscopy and CT scan, demonstr ated a cast-forming tracheobronchial obstructing tumor. Surgical resection of the tumor through the left chest with left lower lobectomy resolved his symptomatology. Improved ventilation with an open airway led to expansion o f the left upper lobe. The pathologic diagnosis remained controversial as t o a definite designation and was primarily descriptive: spindle cell prolif eration with myxoid and collagenized stromal benign tumor. However, the ext ent of this rubbery tumor cast and the ability to remove it intact illustra te the tenacity of the structure and the very unusual nature of a cast of t he entire tracheobronchial system on the left side.