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Assembly

A Dark Case of Cough

Authors
Gbonjubola Onawunmi MD1, Fellow; Evgeniya Angelova MD PhD2, Fellow;
Shawn P.E Nishi MD1 Associate Professor & Fellowship Program Director
1Division of Pulmonary, Critical Care & Sleep Medicine
2Department of Pathology, Division of Cytopathology
University of Texas Medical Branch


Case

An 86 year-old U.S army veteran presents with shortness of breath and chronic cough of several years duration. His cough is productive of white-yellow sputum without hemoptysis. Patient denies weight loss, fever, chills or night sweats. He is a former tobacco user (20 pack-years, quit 1976) and has moderate COPD (GOLD Class A, FEV1 1.50L, FVC 2.82L, FEV1/FVC 53). Past medical history also includes gastroesophageal reflux and diastolic dysfunction. In addition to being an army veteran, he also worked in the coal mines for 30 years. Physical exam is only notable for mild scattered expiratory wheeze bilaterally. He underwent a chest CT (Figure 1) as follow up for an abnormal chest x-ray. Based on the imaging findings, he then underwent flexible bronchoscopy (Figure 2) with endobronchial biopsies (Figure 3).

Figure 1a & Figure 1b

CT Scan

Figure 2

Flexible Bronchoscopy

Figure 3

endobronchial biopsies

Question

What is the diagnosis?

A. Tracheobronchial melanosis
B. Endobronchial melanoma
C. Bronchial anthracofibrosis
D. Kaposi’s sarcoma
E. Soot inhalation

Answer