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CASE PRESENTATION A 62-year-old man, a lifelong nonsmoker with a medical history of diabetes, chronic sinusitis, and hyperlipidemia, presented to our Pulmonary Clinic with more than 2 years of worsening chronic dry cough, with recent new onset of scant hemoptysis and an imaging finding of bronchiectasis. The patient had no history of cigarette smoking or pulmonary infections. His occupation included construction work with exposure to sand and wood. His laboratory work-up revealed within-normallimit infection testing (including negative respiratory culture, acid-fast bacilli, gamma interferon, hepatitis, and human immunodeficiency virus serologies), allergy testing, immune deficiency test (with human immunodeficiency virus and immunoglobulin panel), and pulmonary function test. An x-ray of the patient’s chest demonstrated bibasilar atelectasis without obvious infiltrate (Figure 1). A computed tomography scan of his sinus demonstrated chronic maxillary sinusitis. A computed tomography scan of his chest showed evidence of right lower lobe bronchiectasis and pulmonary sequestration (Figure 2). All the images were ordered by his primary care physician and obtained before his referral to the Pulmonary Clinic. The patient’s chronic cough was then evaluated by an otolaryngologist who found erythema in the interarytenoid area on laryngoscope. Therefore, the patient’s chronic cough was thought to be caused by postnasal drip or gastroesophageal reflux disease. In the past he had been treated with fluticasone nasal spray and omeprazole without significant improvement. The patient’s case was discussed at a regional thoracic conference with thoracic surgeons and interventional radiologists with the conclusion that surgical resection would offer both diagnosis as well as treatment of the symptomatic bronchiectasis. Soon thereafter, a right lower lobectomy was performed via videoassisted thoracoscopic surgery. The surgical pathology specimen revealed multifocal carcinoid tumorlets with focal lymphangitic spread and metastasis to regional lymph nodes (Figure 3). The patient was subsequently referred to the Oncology Department for further evaluation. An octreotide scan was performed and found to be within normal limits. Because his cough had improved and there was no evidence of distal metastasis or signs of carcinoid syndrome, the decision was made for continued close follow-up.

Image Diagnosis: Carcinoid Tumorlets and Pulmonary Sequestration in a Patient With Chronic Cough Without a History of Malignancy