Typical carcinoid tumor originating from the tracheal carina managed with carinal resection and neo-carinal bronchoplastic reconstruction: a case report

Primary tumors of the tracheobronchial tree are uncommon and may be overlooked because symptoms often mimic more prevalent respiratory disorders. A typical carcinoid is a well-differentiated neuroendocrine neoplasm that frequently arises in the central airways; origin from the tracheal carina is exceptional. Marked tumor vascularity may increase bleeding risk and lead to non-representative bronchoscopic biopsies, delaying diagnosis. A 31-year-old Middle Eastern woman, non-smoker and previously healthy, presented with seven months of recurrent hemoptysis that gradually increased to approximately 20–40 mL/day, with mild anemia. Chest radiographs were repeatedly normal. Contrast-enhanced multidetector CT with multiplanar reconstructions demonstrated a small endoluminal lesion at the distal trachea/carina projecting into the proximal left main bronchus, causing near-complete obstruction without parenchymal consolidation or lymphadenopathy. Flexible bronchoscopy revealed a smooth, highly vascular, bleeding polypoid mass arising from the carina and narrowing the left main bronchial orifice by ~ 90%. Initial forceps biopsies suggested a benign vascular lesion. Rigid bronchoscopy with deeper biopsies established typical carcinoid. Given the critical carinal location, friability, and preserved lung parenchyma, definitive surgical management was pursued via median sternotomy with en bloc distal trachea–carina resection. Reconstruction consisted of end-to-end anastomosis between the distal trachea and left main bronchus, followed by end-to-side reimplantation of the right main bronchus into the trachea to recreate a neo-carina. Recovery was uneventful. This case highlights the diagnostic pitfall of superficial sampling in vascular carinal tumors and supports repeat deep sampling when clinicopathologic discordance persists. Multiplanar CT aids operative planning. For selected patients with preserved parenchyma, isolated carinal resection with neo-carinal reconstruction offers definitive, lung-sparing treatment, with reconstructive variants tailored to anatomy and tension considerations. Carinal typical carcinoid is a rare cause of recurrent hemoptysis and may evade diagnosis when biopsies are limited. Integrated imaging, adequate tissue acquisition, and timely bronchoplastic carinal resection can achieve curative, lung-preserving treatment.