Case report: Small cell lung cancer presenting as the “sunray sign” in the chest radiograph and recurrent hemoptysis

Abstract

Lung cancer prognosis has not changed in the last few decades due to diagnosis at an advanced stage. The majority of cases with early disease are asymptomatic, and whenever clinical presentations with cough, dyspnea, hemoptysis, or chest pain occur, when these cases have progressed to an advanced stage. Lung cancer tops the list of all causes of cancer-related deaths globally and is ahead of digestive tract malignancies. Small-cell lung cancer (SCLC) has the worst outcome, with survival rates in the range of weeks to months from diagnosis. SCLC is usually manifested as an extensive disease due to its delayed presentation, early metastasis, systemic nature, and poor response to available treatment options. “sunray sign” in chest radiographs is first described in literature and constitutes a hilar mass or radiopacity with inhomogeneous linear opacities spreading toward the periphery like sunrays, which is a marker of interstitial lymphatic involvement due to malignant spread of disease. The “sunray sign” is an indicator of underlying lung malignancy with central airway or main stem bronchus involvement and lymphatic dissemination in linear opacities. In this case report, we have reported a 51-year-old male who presented with cough and hemoptysis with progressive worsening of shortness of breath. Chest X-rays documented round opacities occupying the right hilum with linear opacities emerging toward the periphery in lung parenchyma, showing the typical “sunray sign.” Bronchoscopy was done after clinical stabilization and showed endobronchial polypoidal growth in the right main stem bronchus, causing partial occlusion of the bronchial lumen. Endobronchial needle aspiration (EBNA) cytology and forceps-guided (FB) histopathology are suggestive of “small cell histological type” lung malignancy for the “sunray sign” in our case. A high index of suspicion is a must to rule out underlying malignancy, and bronchoscopy is the “gold standard” test in cases with the sunray sign to confirm the diagnosis.