A 70-year-old mild former smoker (3 packs/year) male was admitted to the Respiratory Ward of the Santa Maria Nuova Hospital of Reggio Emilia (IT) for persistent cough and fever despite prolonged antibiotic courses and steroid therapy. Past medical history revealed surgical excision of the right vocal cord for a benign vocal cords tumor performed 30 years before. At the time of hospital admission the chest X ray showed a single lung nodular opacity of 1.6 × 1.3 cm in the left upper lobe that was confirmed by a subsequent chest computed tomography (CT) scan. The fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/TC) showed a single area of increased metabolic rate (maximum standardized uptake value (SUV) of 4.5) in the anterior segment of the left upper lobe while abdomen and brain CT scan were negative for other lesions. The patient underwent bronchial video-endoscopy (Olympus BF-H190) that did not identify any endobronchial or intramural alterations in the explorable tracheo-bronchial tree. In particular no signs of mucosal abnormalities or evidence of sub-mucosal lesions were described. Thus a radial endobronchial ultrasound probe (REBUS) was necessary to identify the sub-segmental bronchus were the nodule was located and 5 trans-bronchial biopsies were performed in the apical tract of the anterior segmental bronchus of the left upper lobe (LB3a), with oval fenestrated biopsy forceps (Olympus model no. FB- 231D), without significative bleeding or other complications. Immunohistochemical investigation was broadly positive for chromogranin and synaptophysin while the proliferative index assessed by KI67/MIB1 was about 1%. To complete diagnosis a 68Ga-DOTA-peptide PET/CT was also performed demonstrating a very small area of hyper-folding of the tracer (SUV max equal to 1.6). Based on these results the diagnosis of typical carcinoid of the bronchus stage cT1 cN0 cM0 was made. The patient successfully underwent surgical excision of the upper left lobe and clinic-radiological follow-up was started.