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Abstract

A 60 year male patient, smoker since last 30 years, who had been unsuccessfully treated with inhalational β-2 agonist, corticosteroid and anticholinergic for obstructive airway disease by local physician over last three years, presented with gradually progressive breathlessness over one month and mild dull aching left sided chest pain since six months. On clinicaln examination, patient was found to have features of loss of lung volume on left side anddiminished breath sound over entire left hemithorax. Chest X-ray revealed collapse of left lung. CT scan of thorax showed complete left lung collapse with a mass in left main bronchus. Metastatic nodules were found in liver in CT scan of abdomen. Subsequent fibreoptic bronchoscopy demonstrated a polypoid mass in left main bronchus partially occluding the lumen and biopsy from the mass revealed features of carcinoid tumour. Bronchial carcinoid can sometimes present with features of airway obstruction which leads to a misdiagnosis of the case as asthma or COPD which responds poorly to conventional therapy. So, CT thorax and bronchoscopy are recommended in patients with wheeze whocannot be managed adequately with inhalational therapy to exclude other underlying pathology.