Bronchoscopic resection preceded by bronchial artery embolization of a large bronchial carcinoid tumour : A case report
S. Jain*a (Dr), V. Nandaa (Dr), M. Pilaniyaa (Dr)
a Ramkrishna Care Hospital, Raipur, INDIA
* drsushiljain01@gmail.com
Background: Bronchial carcinoid tumours are relatively rare neuroendocrine tumours and account for about 1-2% of all primary lung malignancies. They are usually well circumscribed, slow growing tumours but have high chances of massive bleeding. The endobronchial carcinoids can be managed by bronchoscopic resection as a less invasive option as compared to surgery. Massive bleeding can be prevented by bronchial artery embolization prior to bronchoscopic resection.
Case report: 29 year old female presented to us with complaints of cough, breathlessness and intermittent mild haemoptysis for last 2 years. Her computed tomography (CT) of chest showed a mass in the right main bronchus with complete collapse of the right lung. Diagnostic bonchoscopy was performed which showed a large, round, highly vascular endobronchial mass completely obstructing the right main bronchus. Endobronchial biopsies from the mass confirmed the diagnosis of typical carcinoid tumour.
The patient was planned for rigid bronchoscopic resection of the endobronchial carcinoid. In view of high risk of bleeding, we did bronchial artery embolization prior to bronchoscopic resection.
Rigid bronchoscopic intubation was done. The endobronchial mass was ablated with holmium laser, followed by piecemeal removal with snare and rigid biopsy forceps. There was minimal bleeding during bronchoscopic resection. Complete resection of the tumour was achieved at the end of the procedure. The patient was discharged the next day.
Conclusion: Bronchoscopic resection is a less invasive option and can be curative in many patients with typical endobronchial carcinoid. Bronchial artery embolization can significantly reduce the chances of massive bleeding during bronchoscopic resection of these tumours and should be considered in these patients prior to doing the procedure.
Disclosure of funding source(s): none