Preoperative embolization of a pulmonary carcinoid tumor with unusual arterial supply: a case report

BACKGROUND: Pulmonary carcinoid tumors are rare neuroendocrine neoplasms that carry a risk of bleeding. We report a case of a tumor with unusual arterial supply from multiple sources including collateral from the renal artery, successfully managed with preoperative embolization followed by surgical resection. CASE PRESENTATION: A 39-year-old woman with no significant medical history presented with chronic cough. Chest radiography revealed an opacity in the right hilar region. Computed tomography (CT) showed a mass obstructing the right middle lobe bronchus. 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated no abnormal uptake in the lesion. However, a Ga-68 DOTATATE somatostatin receptor scan (DOTA-PET) showed intense tracer uptake in the mass. Bronchoscopy identified a reddish endobronchial lesion completely occluding the middle lobe bronchus and causing distal collapse. Biopsy was deferred due to the lesion’s hypervascular appearance. With a presumptive diagnosis of carcinoid tumor, a multidisciplinary team planned for surgical resection. To mitigate intraoperative bleeding, preoperative angiographic evaluation was performed. Digital subtraction angiography (DSA) revealed that the blood supply originated from the right bronchial artery, right internal mammary artery and right renal artery. All identified feeding arteries were selectively catheterized and embolized with coils. The patient underwent a right middle lobectomy. Intraoperative blood loss was minimal, and the tumor was resected completely. Pathology confirmed carcinoid tumor. At two-year follow-up, the patient remains asymptomatic. CONCLUSIONS: This case highlights a rare arterial supply to a lung tumor and demonstrates that preoperative embolization of multiple feeding vessels can facilitate safe resection of a hypervascular tumor. Awareness of vascular anomalies and multidisciplinary approach were key to successful management.