Endotracheal Metastases of Lung Cancer with Refractory Wheezing.

A 78-year-old Japanese woman showed refractory inspiratory and expiratory wheezing and persistent cough for 4 months despite taking a high-dose inhaled corticosteroid with a long-acting beta agonist. She was an ex-smoker of 58 pack-years and had a history of bronchial asthma and right upper-middle lobectomy for small cell lung cancer (SCLC) (pT2aN0M0, Stage IB) 1 year before. On admission, multiple endotracheal and endobronchial nodules were observed on chest computed tomography (Picture 1) without central airway narrowing on chest radiography (Picture 2). A bronchoscopic examination revealed multiple polypoid nodules in the trachea and bilateral main bronchi (Picture 3). A biopsy specimen from the tracheal polypoid lesion revealed metastases from SCLC (Picture 4). She responded to thoracic chemoradiotherapy with carboplatin and etoposide, and her wheezing improved. Endotracheal/endobronchial metastases of SCLC are extremely rare (1,2). However, clinicians should consider central respiratory tract metastasis of SCLC when examining patients with unexplained refractory wheezing.

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The authors state that they have no Conflict of Interest (COI).