Unusual finding in a diagnostic bronchoscopy of a patient with brain metastatic lung cancer

Abstract

Swallowing disorders are common manifestations in patients with advanced lung cancer, this paper describes a rare clinical case of a foreign body (chicken bone) accidently found in the lumen of the left upper lobe bronchus during bronchoscopy. A 41 year- old man, with smoking history of 20 PA presented to our department with paraplegia and left arm paresis, he complained over 6 months from dyspnea, increasing posterior chest pain and persistent dry coughing. He had a history of swallowing disorders and difficulties with shocking episode passed unnoticed. The patient was apyretic but presented weight loss and weakness. On physical examination, he had a digital hippocratism, a WHO performance status was at 4 and there were diffuse snoring rales on pulmonary auscultation. The body CT scan showed a voluminous left upper mediastinal tumor involving the left upper lobe and the left apical pyramidal lobe, this tumor was extended to vascular elements and to the dorsal spine. The cerebral CT scan showed discreetly a compressive right parietal process measuring 3cm*3cm. The flexible bronchoscopy has been performed showing an extrinsic compression of the posterior wall of the trachea, a blood clot removed showing a piece of chicken bone presented in the lumen of the anterior segmental bronchus. The patient was referred to the oncology department for palliative treatment, after being diagnosed as lung adenocarcinoma by a CT guided lung biopsy. This is the first paper reported an accidently discovery of bronchial foreign body during bronchoscopy in a patient with stage IVB lung cancer. Dysphagia has been reported as common manifestation in patients with advanced lung cancer due to underlying mediastinal disease and brainstem lesions metastasis, it is considered as a disorder which may increase the risk of morbi-mortality and has a potential of life-threatening.