Presenter Status
Resident/Psychology Intern
Abstract Type
Case Report
Primary Mentor or Principal Investigator
Stephen Cliff
Presentation Type
Poster
Start Date
21-5-2026 11:00 AM
End Date
21-5-2026 12:00 PM
Abstract Text
Background: Primary endobronchial carcinoids are the most common primary pulmonary neoplasm in pediatrics. Obstructive tumors can present as cough, asymmetric wheezing, and changes to chest imaging. In children, these symptoms are frequently misattributed to asthma, resulting in delays in diagnosis and treatment. Early recognition is critical as complete surgical resection is typically curative and associated with low recurrence rates.
Goal: To describe serial pulmonary function testing across the entire disease course of a pediatric patient with an endobronchial carcinoid tumor.This case highlights dynamic changes in airflow limitation and lung volumes that correlate with the degree of airway obstruction and subsequent restoration of airflow.
Design: Case report with accompanying literature review.
Results: A 13-year-old female with asthma and seasonal allergies presented to the pediatric pulmonary clinic with persistent cough, exertional dyspnea, and wheezing following a viral respiratory tract infection. She had recently completed a 10-day course of prednisone and was started on Symbicort without clinical improvement.
Examination demonstrated asymmetric monophonic wheezing over the left chest. Pulmonary function testing (PFT) showed moderate restrictive airflow limitation without bronchodilator response. Chest radiograph demonstrated asymmetric hyperinflation of the left lung with rightward cardiac displacement, prompting hospital admission for expedited evaluation.
Computed tomography (CT) chest revealed a 19 mm endobronchial mass with a possible extra-bronchial component compressing the left mainstem bronchus with complete occlusion of the left upper lobe bronchus with diffuse post-obstructive atelectasis. Laboratory evaluation revealed leukocytosis with left shift, macrocytic anemia, and elevated C-reactive protein with otherwise normal tumor and metabolic markers.
Bronchoscopy with ultrasound-guided endobronchial biopsy demonstrated a neuroendocrine neoplasm consistent with a carcinoid tumor. After bronchoscopic tumor debulking, she experienced clinical improvements and was discharged for additional diagnostics and definitive surgical management. Repeat PFTs at discharge demonstrated improved forced vital capacity (FVC) with unchanged forced expiratory volume in one second (FEV₁) resulting in an obstructive airflow limitation with high residual volume to TLC ratio suggesting air trapping was present.
Positron emission tomography showed focal uptake in the left upper lobe concerning for higher-grade tumor involvement. She subsequently underwent left upper lobe sleeve lobectomy with lymph node sampling. Pathology confirmed an atypical carcinoid tumor with increased mitotic activity but no necrosis or nodal metastasis. Six months postoperatively, PFTs demonstrated normalized lung function, with improved FVC, FEV1, and normalized FEV1/FVC ratio. She remained asymptomatic off inhaled corticosteroid therapy.
Conclusions: Although bronchial carcinoid tumors are rare, they should be considered in cases of recurrent or asymmetric wheezing unresponsive to standard asthma therapy. PFTSs are not routinely performed in workup of bronchial carcinoid tumors, leading to limited data on the expected spirometry changes in pediatrics. This report is unique as it trends serial PFTs throughout the course—before diagnosis, after tumor debulking, and following resection— demonstrating an initial restrictive pattern which progressed to an obstructive pattern with air trapping which ultimately normalized postoperatively. The PFTs changes expectedly correlate with the degree of airway occlusion of the tumor as proper airflow is gradually restored.
Persistent Wheezing in an Adolescent Patient
Background: Primary endobronchial carcinoids are the most common primary pulmonary neoplasm in pediatrics. Obstructive tumors can present as cough, asymmetric wheezing, and changes to chest imaging. In children, these symptoms are frequently misattributed to asthma, resulting in delays in diagnosis and treatment. Early recognition is critical as complete surgical resection is typically curative and associated with low recurrence rates.
Goal: To describe serial pulmonary function testing across the entire disease course of a pediatric patient with an endobronchial carcinoid tumor.This case highlights dynamic changes in airflow limitation and lung volumes that correlate with the degree of airway obstruction and subsequent restoration of airflow.
Design: Case report with accompanying literature review.
Results: A 13-year-old female with asthma and seasonal allergies presented to the pediatric pulmonary clinic with persistent cough, exertional dyspnea, and wheezing following a viral respiratory tract infection. She had recently completed a 10-day course of prednisone and was started on Symbicort without clinical improvement.
Examination demonstrated asymmetric monophonic wheezing over the left chest. Pulmonary function testing (PFT) showed moderate restrictive airflow limitation without bronchodilator response. Chest radiograph demonstrated asymmetric hyperinflation of the left lung with rightward cardiac displacement, prompting hospital admission for expedited evaluation.
Computed tomography (CT) chest revealed a 19 mm endobronchial mass with a possible extra-bronchial component compressing the left mainstem bronchus with complete occlusion of the left upper lobe bronchus with diffuse post-obstructive atelectasis. Laboratory evaluation revealed leukocytosis with left shift, macrocytic anemia, and elevated C-reactive protein with otherwise normal tumor and metabolic markers.
Bronchoscopy with ultrasound-guided endobronchial biopsy demonstrated a neuroendocrine neoplasm consistent with a carcinoid tumor. After bronchoscopic tumor debulking, she experienced clinical improvements and was discharged for additional diagnostics and definitive surgical management. Repeat PFTs at discharge demonstrated improved forced vital capacity (FVC) with unchanged forced expiratory volume in one second (FEV₁) resulting in an obstructive airflow limitation with high residual volume to TLC ratio suggesting air trapping was present.
Positron emission tomography showed focal uptake in the left upper lobe concerning for higher-grade tumor involvement. She subsequently underwent left upper lobe sleeve lobectomy with lymph node sampling. Pathology confirmed an atypical carcinoid tumor with increased mitotic activity but no necrosis or nodal metastasis. Six months postoperatively, PFTs demonstrated normalized lung function, with improved FVC, FEV1, and normalized FEV1/FVC ratio. She remained asymptomatic off inhaled corticosteroid therapy.
Conclusions: Although bronchial carcinoid tumors are rare, they should be considered in cases of recurrent or asymmetric wheezing unresponsive to standard asthma therapy. PFTSs are not routinely performed in workup of bronchial carcinoid tumors, leading to limited data on the expected spirometry changes in pediatrics. This report is unique as it trends serial PFTs throughout the course—before diagnosis, after tumor debulking, and following resection— demonstrating an initial restrictive pattern which progressed to an obstructive pattern with air trapping which ultimately normalized postoperatively. The PFTs changes expectedly correlate with the degree of airway occlusion of the tumor as proper airflow is gradually restored.
Comments
Poster Board Number: 5