CTICasesTracheobronchial Dissemination of Carcinoid Tumor
Imaging findings
CT shows multiple small nodules lining the trachea and bronchi, initially thought to represent papillomatosis or amyloid. On retrospective review of prior imaging, the patient presented in 2009 with right lower lobe atelectasis and an enhancing endobronchial tumor consistent with carcinoid, which was resected via right lower lobectomy. By 2014, multiple polypoid lesions had developed in the trachea and larger airways requiring laser excision, and the current study shows widespread small nodules distributed throughout the tracheobronchial tree.
Key takeaways
Typical bronchial carcinoid can disseminate through the tracheobronchial tree in a phenomenon that may result from intraluminal shedding and seeding of tumor cells during bronchoscopic procedures or resection. The imaging appearance of multiple small airway nodules in a patient with prior endobronchial carcinoid should raise this diagnosis. The dissemination pattern differs from pulmonary metastases and may require repeated bronchoscopic treatment with laser excision or other debulking techniques. The group proposed the term diffuse idiopathic tracheal neuroendocrine cell hyperplasia for a similar entity.
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