CTICasesAtypical Carcinoid Tumor Causing Left Lower Lobe Collapse
Imaging findings
PA chest radiograph shows a retrocardiac opacity obscuring the medial hemidiaphragm with compensatory hyperinflation of the remaining left upper lobe, a subtle spine sign, and a depressed, medially rotated left hilum with the diverging-vessel sign, all consistent with left lower lobe atelectasis; the lateral view confirms loss of the posterior hemidiaphragm. PET/CT shows an enhancing, partially calcified endobronchial nodule at the left lower lobe bronchus extending into the mainstem bronchus.
Key takeaways
Outside biopsy favored small cell carcinoma based on nonspecific blue-cell morphology, but left pneumonectomy confirmed atypical carcinoid tumor -- a reminder that an enhancing, calcified endobronchial lesion favors carcinoid over small cell carcinoma, and that vascular findings such as the diverging-vessel sign and hilar depression/rotation are underappreciated but valuable signs of lobar collapse.
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