DISCUSSION: The diagnosis of DIPNECH can be challenging. Review of the literature shows a limitation in the use of serum biomarkers because neuroendocrine products cannot be broken down into readily measured levels. CT scan of the chest usually reveals small sub-centimeter nodules, which are less than 5mm in 60% of cases. Mosaic attenuation is also commonly found. Less common findings are ground glass opacities as well as bronchiectasis; however, no radiological finding is pathognomonic. The role of bronchoscopy is unclear as there are no specific findings on bronchiolar lavage although some reports of diagnoses of DIPNECH through trans-bronchial biopsies have been described. The gold standard for diagnosis is a surgical lung biopsy.2 In order to ensure histopathological diagnosis of DIPNECH, neuroendocrine cell hyperplasia must be seen. Carcinoid tumorlets are seen in more than 70% of patients and as was seen in our patient. Various treatment strategies have been described including systemic/inhaled steroids, bronchodilators and lung resection.