Abstract A 66-year-old woman with a history of melanoma of the upper back, treated with excision and immunotherapy in 2021, developed right cervical nodal metastases requiring neck dissection with multiple positive nodes. She achieved complete remission following immunotherapy, and remained disease-free on surveillance PET/CT through January 2025.By June 2025, she reported progressive dyspnea and fatigue. Repeat PET/CT revealed a new 6 cm hypermetabolic left upper-lobe mass with mediastinal and hilar adenopathy and osseous metastases. Robotic bronchoscopy identified a completely obstructing endobronchial mass at the left upper-lobe orifice; biopsy confirmed small cell lung carcinoma (SCLC). Before planned chemotherapy, she was admitted to the hospital with worsening dyspnea. CT angiography showed rapidly enlarging mediastinal nodes causing severe compression of the left main pulmonary artery and complete occlusion of the left upper-lobe bronchus with lobar collapse. Patient was deemed not a candidate for surgical intervention. Interventional radiology performed endovascular stenting of the left pulmonary artery using a 16 × 40 mm self-expanding bare-metal stent, restoring perfusion and improving oxygenation. Dual antiplatelet therapy with aspirin and clopidogrel was initiated.She subsequently began carboplatin-etoposide chemotherapy and underwent rigid bronchoscopy with argon plasma coagulation and balloon dilation, which revealed non-stentable extrinsic compression of the left mainstem bronchus/left upper lobe/left lower lobe orifices.Malignant pulmonary artery compression from newly diagnosed SCLC is rare but potentially reversible. Endovascular stenting can provide rapid symptomatic improvement when surgical or bronchoscopic options are limited, emphasizing the value of multidisciplinary management. A. Axial CT chest before pulmonary artery stenting showing severe left pulmonary artery compression. B. Axial CT chest after stent placement demonstrating restored vessel patency. This abstract is funded by: None
Nieto et al. (Fri,) studied this question.