Presentation
Cough and fever for 3 days, with elevated inflammatory markers.
Patient Data
ill-defined triangular right mid zone air space opacification obscuring the right heart border
medial convexity of the inferior right hilum adjacent to the interlobar artery.
The patient was treated with antibiotics but presented a month later with a recurrence of the symptoms.
Compared to day 1 chest x-ray:
decreased size of the right mid-zone air space opacification and increased attenuation
elevation of the right hemidiaphragm
crowding of the inferior right ribs
CT was subsequently performed to elucidate the findings.
complete obstruction of the middle lobe bronchus upstream of a hypervascular intrabronchial nodule
middle lobe collapse and consolidation
Obstruction of the right middle lobe bronchus by the endoluminal nodule is well seen on both soft-tissue and lung reformats.
Bronchial biopsy summary: Well-differentiated neuroendocrine tumor of carcinoid type. The typical or atypical subtype cannot be determined on this biopsy sample.
Case Discussion
Although carcinoid tumors account for <1% of primary lung tumors, they are the most frequent lung tumor in childhood and adolescence. 80% occur centrally and can present with obstructive pneumonia.
Chest X-ray interpretation is challenging. The medial convexity on the initial radiograph corresponds with the location of the tumor in the middle lobe bronchus.
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