Correct!
4. Dieulafoy’s disease
Dieulafoy’s lesion is a developmental vascular malformation usually seen in the gastrointestinal tract but occasionally the lungs. It is an enlarged submucosal blood vessel that bleeds in the absence of any abnormality, such as ulcers or erosions. Dieulafoy's lesion may cause a nodular endobronchial appearance, but often a white “cap” may be seen, the mucosal may be congested, and tortuous dilated submucosal blood vessels may be evident. The latter contribute to hemoptysis when present, and this patient never complained of such. The other lesions listed may result in an endobronchial nodular appearance as seen in this patient, and the visual appearance of these lesions may be similar.
The bronchoscopic biopsy revealed histologic feature consistent with carcinoid tumor. The patient underwent video-assisted left lower lobe resection with pathologic confirmation of carcinoid tumor. Her Cushing syndrome subsequently resolved.
Diagnosis: Endobronchial carcinoid tumor causing recurrent Cushing syndrome
References