C78-25 Impending Doom: Tracheobronchial Metastatic Spread Threatening Airway Patency in Recurrent Lung Cancer

Abstract Background Endotracheal and endobronchial metastases from primary lung cancer are uncommon but clinically significant, particularly when airway patency is threatened. Airway involvement may remain subtle until critical obstruction develops, making early bronchoscopic evaluation essential for diagnosis and management. We present a case of suspected tracheobronchial metastasis in a patient with metastatic lung adenocarcinoma, highlighting the complementary roles of positron emission tomography-computed tomography (PET-CT) and bronchoscopy in detecting airway-compromising disease. Case Presentation A 67-year-old woman with metastatic left lung adenocarcinoma, diagnosed in 2008, treated with chemotherapy and radiation, and chronic obstructive pulmonary disease, presented after surveillance positron emission tomography-computed tomography demonstrated new hypermetabolic pulmonary nodules and circumferential tracheobronchial mucosal thickening. She reported chronic cough with intermittent coughing up of blood, but denied shortness of breath, fever, or other systemic symptoms. Flexible bronchoscopy revealed diffuse, circumferential, friable nodularity involving the trachea and proximal bronchi, causing partial but noncritical airway narrowing. Endobronchial biopsies, brushings, and bronchoalveolar lavage were obtained. Preliminary pathology favored carcinoma. No immediate airway intervention was required, and the patient remained clinically stable under close pulmonary and oncology follow-up while awaiting final histopathologic confirmation and systemic treatment planning. Discussion Airway metastases from lung cancer are rare and often underrecognized. Positron emission tomography-computed tomography can identify metabolically active tracheobronchial lesions, prompting timely bronchoscopic evaluation before critical obstruction develops. In this case, diffuse endobronchial tumor spread was present despite minimal respiratory symptoms, emphasizing that airway compromise may progress silently. Bronchoscopy remains indispensable for diagnosis, tissue confirmation, and therapeutic assessment, offering interventions such as mechanical tumor removal, ablative techniques, or stent placement when obstruction occurs. Early identification allows proactive airway management and rapid escalation of therapy if clinical deterioration ensues. References 1- Zhang Z, Mao Y, Chen H, Dong J, Yang L, Zhang L, Wang F. Endotracheal and endobronchial metastases in a patient with stage I lung adenocarcinoma. Ann Thorac Surg. 2014 May;97(5):e135-7. doi: 10.1016/j.athoracsur.2013.09.064. PMID: 24792301. 2- Godoy MCB, Truong MT, Jimenez CA, Shroff GS, Vlahos I, Casal RF. Imaging of therapeutic airway interventions in thoracic oncology. Clin Radiol. 2022 Jan;77(1):58-72. doi: 10.1016/j.crad.2021.09.012. Epub 2021 Nov 1. PMID: 34736758. 3- Guibert N, Mazieres J, Marquette CH, Rouviere D, Didier A, Hermant C. Integration of interventional bronchoscopy in the management of lung cancer. Eur Respir Rev. 2015 Sep;24(137):378-91. doi: 10.1183/16000617.00010014. PMID: 26324799; PMCID: PMC9487693. This abstract is funded by: None