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Imaging: Pulmonary Nodules |

An Under Recognized Cause of Chronic Cough: Diffuse Idiopathic Pulmonary Neuroendocine Cell Hyperplasia (DIPNECH)

Whittney Warren, DO; William Kelly, MD
Author and Funding Information

Walter Reed National Naval Medical Center, Bethesda, MD


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A255. doi:10.1016/j.chest.2016.02.266
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Extract

SESSION TITLE: Pulmonary Nodules

SESSION TYPE: Case Report Slide

PRESENTED ON: Saturday, April 16, 2016 at 01:00 PM - 02:00 PM

INTRODUCTION: DIPNECH is a rare cause of chronic cough that should be considered in patients with wheezing, dyspnea and multiple small pulmonary nodules.

CASE PRESENTATION: A 64-year-old male former smoker presented to pulmonary clinic complaining of non productive cough for ten years. Prior evaluation included treatment for upper airway cough syndrome and gastroesophageal reflux, stopping ACE-I, inhaled beta-agonists, and a negative bronchoscopy. Physical examination was unremarkable. Serial PFTs evolved from normal to mixed pattern with airway hyperactivity. Chest CT showed a 1.7 cm lingua nodule (1.2 cm 10 years prior), with numerous bilateral 3-4 mm pulmonary nodules. Scattered areas of mosaicism and ground glass opacity were appreciated on the updated higher resolution CT. Surgical resection demonstrated typical carcinoid with associated tumorlets and no lymph node metastasis. Postoperative octreoscan was negative but chromogranin and HIAA levels were elevated. Management included inhaled corticosteroids and serial imaging with somatostatin analogue to be considered in the future.

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