Case 1

A 38 year old woman was referred to the chest clinic by her general practitioner. She was 31 weeks pregnant and reported an eight week history of fever, dry cough, and left sided chest pain. Despite repeated courses of oral antibiotics her symptoms had slowly worsened, resulting in a referral for specialist review. On examination she had decreased breath sounds at the left lung apex, left basal crackles, and soft expiratory wheeze. A chest radiograph showed a mass at the left hilum and left upper lobe collapse (fig 1⇓). Urgent bronchoscopy revealed a large vascular tumour obstructing the left upper lobe. A computed tomography (CT) scan confirmed a hypervascular lesion centred on the left upper lobe bronchus, which was most consistent with a carcinoid tumour, and several lymph nodes in the prevascular space.

She had an elective caesarean section at 35 weeks followed by a left …