Margita Belicová, Dana Prídavková, Ján Dvorský, Marian Mokáň
Typical bronchial carcinoids are usually situated near hili, they often produce hormones and might be a reason of absence of lung perfusion even when atelectasis absents. Carcinoid crisis is life threatening complication, which can happen spontaneously, more often it is caused by stress. Clinical manifestation includes dyspnoea, hypotension and acute right heart failure. In case of absence of lung perfusion it can imitate acute pulmonary embolism with high risk. In this case, authors describe 55 year old patient, who underwent primary PCI because of STEMI and after 48 hours acute dyspnoea, hypotension and right heart failure appeared. Transthoracic echocardiography revealed dilatation and dysfunction of right ventricle, tricuspid regurgitation and pulmonary hypertension. Scintigraphy revealed absence of left lung perfusion while chest x-ray showed no pathology. CT angiography excluded pulmonary embolism and revealed tumour sized 14x12 mm in left main bronchus, just before its branching. Bronchofibroscopy was proceeded and revealed polyp which obturated the left main bronchus, suspected from carcinoid, which was histologically confirmed later. High level of 5-hydroxyindolacetate acid in urine confirmed hormonal activity of carcinoid and octreoscan excluded its metastases. After 2 months the patient underwent the operation of tumour without complications.