대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 1151 Date 2019-11-19

  • Courtesy of Young Hun Jeon, Yeong Tae Park, Jin Young Yoo / Chungbuk National University Hospital
  • Age/Sex 53 / F
  • Chief ComplaintCough (onset: 20 days ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Endobronchial atypical carcinoid tumor
Radiologic Findings
Fig 1. Chest PA shows atelectasis of right upper lobe
Fig 2-6. On the pre and post contrast enhanced CT scan, a well-defined highly enhancing mass (2.0x2.2x2.1cm) is seen in right hilar area. Obstruction of right upper lobar bronchus and multifocal consolidation with GGA is noted in right upper lobe, suggestive of obstructive pneumonitis.

On bronchoscopy, there is a hypervascular mass within right main bronchus which is correlated with chest CT. On angiography, well-defined highly vascular mass supplied by right bronchial artery is revealed.
Brief Review
Bronchial carcinoid tumors are classified as neuroendocrine neoplasms of the lung and they arise in the bronchial and bronchiolar epithelium. Bronchial carcinoids range from low-grade typical carcinoids to intermediate-grade atypical carcinoids to high-grade small cell carcinomas. Typical and atypical bronchial carcinoids have similar imaging features. Because most bronchial carcinoids (80-85% of cases) are located in central airways, radiologic findings are usually related to bronchial obstruction.
On computed tomography (CT), Central bronchial carcinoids manifest as an endobronchial nodule or hilar or perihilar mass with a close anatomic relationship to the bronchus. The mass is usually a well-defined, round or ovoid lesion and may be slightly lobulated. Associated atelectasis, air trapping, obstructing pneumonitis, and mucoid impaction may also be seen. Peripheral bronchial carcinoids appear as solitary nodules. Calcification is visible on CT in 30% of cases. Carcinoids have a rich vascular stroma and often show marked, homogeneous enhancement on CT after intravenous administration of contrast material.
On bronchoscopy, bronchial carcinoids are in a central location within reach of a bronchoscope. They appear as smooth, cherry red, polypoid endobronchial nodules. Massive hemorrhage can be occurred due to biopsy. Prognosis of bronchial carcinoids is highly dependent on histologic findings. Recommended treatment of resectable atypical carcinoid tumor is completely surgical resection. And for unresectable case, chemotherapy with or without radiation therapy is recommended.
Please refer to
Case 22, Case 810,
KSTR Imaging Conference 2000  Case 3 ,
KSTR Monthly Case Conference on 2003 Fall (with McAdams)  Case 1,
References
1. Jeung MY et al. Bronchial carcinoid tumors of the thorax: spectrum of radiologic findings. Radiographics 2002 Mar-Apr;22(2):351-65.
Keywords
Airway, Atypical Carcinoid, Malignant tumor,

No. of Applicants : 57

▶ Correct Answer : 35/57,  61.4%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Chonnam National University Hwasun Hospital , Korea (South) INWOO CHOI
  • - McGill University Health Center , Canada Alexandre Semionov
  • - , Korea (South) CHOHEE KIM
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - , Turkey GOKHAN ARSLAN
  • - Other , Korea (South) SEONGSU KANG
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - The Jikei university , Japan TAKU GOMI
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Other , Korea (South) JUWON KIM
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Colombia MANUEL ALEJANDRO LOPEZ-ARROYAVE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan KAZUMA TERAUCHI
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - Chonnam National University Hospital , Korea (South) JONG EUN LEE
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 10/57,  17.5%
  • - McGill , Canada ADRIANA SOFIA MORALES
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - chp st martin , France BENOIT HENR MARIOTTE
  • - , Korea (South) JANG SEONG WON
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan YUMI MAEHARA
▶ Semi-Correct Answer : 2/57,  3.5%
  • - , Korea (South) JIN YOUNG LEE
  • - , Korea (South) KIM DOWOO
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