A Quite Exceptional Cause of Recurrent Hemoptysis Maria R. Ghigna, MD, Élie Fadel, MD, PhD, Roberto Bellini, MD, Adela Rohnean, MD, Laurent Palazzo, MD, Peter Dorfmuller, MD, PhD, Philippe Dartevelle, MD, Vincent Thomas de Montpréville, MD  CHEST  Volume 144, Issue 5, Pages 1724-1728 (November 2013) DOI: 10.1378/chest.12-1004 Copyright © 2013 The American College of Chest Physicians Terms and Conditions

Figure 1 A-C, Coronal sections through the most posterior tracheal extremity without contrast, at peak systemic arterial time (delay of 27 s set with a test bolus), and at an equilibrium phase (3-min postarterial phase), showing this bulging soft tissue mass protruding into the airways at this level without significant stenosis (partial volume effects due to coronal reconstructions). The mass exhibits more prominent vascularization at the periphery. The mean density of this lesion varies from 46 (native examination) to 63 Hounsfield units during the arterial phase and 76 Hounsfield units at the equilibrium phase. The heterogeneous aspect of the lesion during the peak systemic arterial phase with delineation of a slightly less vascularized central zone probably reflects some regressive changes. D, The most prominent of the five associated left-sided laterotracheal lymph nodes (the others were millimeters in size), measuring 1 and 1.6 cm and appearing well delineated, oval, and slightly enhancing after iodinated bolus injection, which proved to be only an inflammatory reactive adenopathy after the anatomopathologic study. E and F, Endoscopic ultrasound findings showing a well-delimited paraesophageal mass. CHEST 2013 144, 1724-1728DOI: (10.1378/chest.12-1004) Copyright © 2013 The American College of Chest Physicians Terms and Conditions

Figure 2 A, Surgical specimen (inset) and histologic view of the tracheal lesion, showing a solid tumor underlying the respiratory mucosa (hematoxylin-eosin [HE], original magnification × 2). B, Paraffin-embedded tissue samples presenting a nested proliferation of regular, medium-sized cells (small image on upper half of image) (HE, original magnification × 40) expressing smooth muscle actin (large image on lower half of image) (HE, original magnification × 20). CHEST 2013 144, 1724-1728DOI: (10.1378/chest.12-1004) Copyright © 2013 The American College of Chest Physicians Terms and Conditions