A Rare Endobronchial Lipoma of the Right Middle Lobe Causing Middle Lobe Syndrome and Recurrent Post‐Obstructive Infection in a Patient With Interstitial Lung Disease, Managed by Lung‐Sparing Bronchoscopy

ABSTRACT

Endobronchial lipomas are rare benign tumours that can cause airway obstruction and recurrent infection. A 70‐year‐old smoker with combined pulmonary fibrosis and emphysema presented with recurrent right middle lobe infections and declining pulmonary function. Computed tomography revealed a fat‐density lesion obstructing the middle lobe bronchus, with atelectasis and consolidation. Bronchoscopy and histology confirmed lipoma. Given limited respiratory reserve, lung‐sparing flexible bronchoscopy with snare electrocautery and argon plasma coagulation restored airway patency; retained purulent secretions were drained and infection treated. At 2 months, the patient was asymptomatic with radiological resolution; FVC improved from 75% to 83% predicted and DLCO from 35% to 50% predicted. Recovery followed concurrent recanalization, drainage and antimicrobial treatment, whose individual contributions cannot be separated. This case highlights bronchoscopic diagnosis and treatment of benign obstruction in persistent middle lobe disease. Longer surveillance is needed to assess durability.