Pleural carcinoid diagnosed via video-assisted thoracoscopy biopsies in a patient with recurrent unilateral pleural effusion at St. Francis hospital Nsambya: a case report

Pulmonary carcinoids are rare neuroendocrine tumors accounting for less than 1% of all lung cancers. They are classified into two subcategories; typical and atypical carcinoids with the latter tending to grow faster. Historically, open thoracotomy was the standard approach for pulmonary resection. However, in the recent years, video-assisted thoracoscopy has gained popularity and become the preferred technique for resectioning pulmonary carcinoids. This report details the diagnosis and management of a pleural carcinoid tumor in a patient with recurrent unilateral pleural effusion.

A 77-year-old African male with a history of hypertension and heart failure with reduced ejection presented with a 6-month history of an irritating non-productive cough, occasional productive episodes and exertional dyspnea but no history of hemoptysis, chest pain, orthopnea, evening fevers, or significant weight loss. Despite multiple interventions, including tube drainage and antituberculosis medications, symptoms persisted. A chest X-ray was performed and it revealed a homogeneous opacity on the left, and a computed tomography scan showed mild pleural thickening especially at the bases. Video-assisted thoracoscopy was performed revealing thickened pleural and biopsies confirmed a diagnosis of malignant carcinoid tumor. The patient underwent successful pleurodesis, resulting in significant improvement.

This case highlights the pivotal role of video-assisted thoracoscopy in diagnosing and managing rare cases such as pulmonary carcinoids when less invasive methods such as thoracentesis fail.