A case of diffuse endobronchial metastasis of rectum carcinoma presenting with symptoms of diffuse airway obstruction and respiratory failure

Abstract

Endobronchial metastases of extra pulmonary tumors are rare. This report presents a case withdiffuse endobronchial metastases with rectum carcinoma. A 63-year-old non-smoker female wasadmitted to our outpatient clinic with dyspnea and dry cough for two months. She had a history ofrectum carcinoma and resection surgery eight months ago. On physical examination, wheezing wasremarkable. There was patchy consolidation in both lung fields on chest x-ray. PET-CT revealedwidespread nodules in pulmonary parenchyma which were consistent with rectal cancer metastasis.Bronchoscopy was performed and revealed extensive mucosal infiltration and multiple varioussizes of polypoid lesions in the distal trachea and both main lobar bronchus. The histopathologicalevaluation reported as metastasis of rectum carcinoma. The oncological medical treatment regimenand radiotherapy was also planned. She admitted to emergency department with chest pain andprogressive dyspnea 2 months after the diagnosis. Thorax CT demonstrated that increased metastaticperibronchial infiltrates, septal thickening and endobronchial polypoid lesions which was consistedwith lymphangitic carsinomatosis and endobronchial metastasis. There was hypercapnic respiratoryfailure according to arterial blood gases analysis. She was intubated and admitted to the intensivecare unit (ICU) and died in ICU on 7th day of admission. This case indicates that the possibility ofendobronchial metastasis should be considered in a patient with underlying malignancy. If availablebronchoscopic intervention should be planned not to let misdiagnosis.