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Weekly Chest CasesArchive of Old Cases

Case No : 1060 Date 2018-02-19

  • Courtesy of Junyoung Lee, MD, Yo Won Choi, MD. / Hanyang University Hospital, Hanyang University College of Medicine
  • Age/Sex 59 / F
  • Chief ComplaintCough, sputum, dyspnea / underlying asthma
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Typical carcinoid tumor
Radiologic Findings
1. Chest PA view shows consolidation obliterating the right lower heart border.
2-4. Enhanced CT of the chest show a proximal bronchial lesion of right middle lobar bronchus with distal pulmonary consolidation suggestive of obstructive pneumonia. The endobronchial obstructive lesion appears well-enhanced. Attenuation of the endobronchial lesion was 60HU on enhanced CT.
5. Chest PA obtained 3 years ago shows similar consolidation in the right middle lobe.
6. A bronchoscopic image shows a highly vascular submucosal tumor obstructing the right middle lobe bronchus.
Brief Review
Bronchial carcinoids are uncommon pulmonary neoplasms and represent 1%–2% of all lung tumors. Patients are often symptomatic and present with cough and recurrent pulmonary infection. Hemoptysis is frequent and occurs in approximately 50% of patients. Typical and atypical bronchial carcinoids share similar imaging features. The mass is characteristically well circumscribed, is rounded or ovoid, and may have a notched or lobulated contour. These lesions typically range in size from 2 to 5 cm.
At CT, carcinoid tumors appear as a spherical or ovoid nodule or mass with a well-defined and slightly lobulated border. When nonspherical, the tumors have an elongated shape, with the long axis parallel to adjacent bronchi or pulmonary artery branches. They are typically located close to central bronchi, often near the bifurcation area. Calcification is usually not visible on chest radiographs, but on CT images calcification or ossification can be seen in up to 30% of tumors and manifests in a punctate or diffuse pattern.
Carcinoids tend to be vascular and may demonstrate intense enhancement. This is particularly helpful for distinguishing the tumor from obstructive atelectasis or an adjacent mucus plug. Also, in a dynamic contrast-enhanced CT study, typical carcinoid and atypical carcinoid show high enhancement more than 30 HU of net enhancement.

References
1. Rosado de Christenson ML, Abbott GF, Kirejczyk WM, Galvin JR, Travis WD. Thoracic carcinoids: radiologic-pathologic correlation. RadioGraphics 1999;19:707–736.
2. Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings. RadioGraphics 2006;26:41–57.
Keywords
Airway, Neoplasm,

No. of Applicants : 95

▶ Correct Answer : 10/95,  10.5%
  • - MD , India DEEPANDER SINGH RATHORE
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Qatif Central Hospital , Saudi Arabia Hani Makky Al Salam
  • - HHS , Canada S LEE
  • - Louisiana State University - Shreveport , United States CARLOS H PREVIGLIANO
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Hamamatsu university school of medicine , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
▶ Correct Answer as Differential Diagnosis : 22/95,  23.2%
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Other , Korea (South) SEONGSU KANG
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Gifu University Hospital , Japan Yo Kaneko
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) HAYEON LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Seoul National University Hospital , Korea (South) YONGSUB SONG
  • - Jiangsu province hospital , China WANGJIAN ZHA
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