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Pulmonary hamartomas are the most common benign tumor of the lung. As the term “hamartoma” suggests, these tumors were at one time considered to be embryological malformations. New evidence indicates, however, that hamartomas are benign tumors of mesenchymal origin and that “mesenchymoma” is a more appropriate term. Despite the fact that hamartomas, or mesenchymomas, have been described in the medical literature since 1904, there is not a consistent methodology for the diagnosis and management of these lesions. This report reviews the available literature regarding pulmonary hamartomas with 3 illustrative cases. An algorithm is proposed for the diagnosis and management of this benign respiratory neoplasm.