Complications of Small Cell Lung Cancer Involving the Carina and Treatment with a Y-Stent

CHUM Endoscopic Tracheobronchial and Oesophageal Centre, Division of Thoracic Surgery, University of Montreal, Montreal, Quebec Correspondence: Dr Moishe Liberman, Department of Surgery, Division of Thoracic Surgery, Centre Hospitalier de l’Universite de Montreal, 1560 Sherbrooke Street East, 8th CD, Pavillon Lachapelle, Suite D-8051, Montreal, Quebec H2L 4M1. Telephone 514-890-8000 ext 26252, fax 514-412-7855, e-mail moishe.liberman@umontreal.ca The ‘Images in Respiratory Medicine’ section of the Canadian Respiratory Journal aims to highlight the importance of visual interpretation, whether physiological, radiological, bronchoscopic, surgical/thorascopic or histological, in the diagnosis of chest diseases. Submissions should exemplify a classic, particularly dramatic or intriguing presentation of a disease while offering an important educational message to the reader (insightful diagnostic pearls or differential diagnosis, etc). This section is not intended to be a vehicle for publication of case reports (see the Clinical-Pathologic-Conferences for case-based leaning series). Small cell lung cancer (SCLC) is a neuroendocrine tumour that is strongly linked with cigarette smoking and accounts for 15% to 25% of lung cancers. SCLC is discerned from non-SCLC by its rapid tumour doubling time and early dissemination. Patients with SCLC may present with varying signs and symptoms such as bloody sputum, chest pain, loss of appetite, shortness of breath, wheezing and weight loss. In the present article, we depict three different carinal complications of SCLC in three different patients. The bronchoscopy performed on the first patient shows an extrinsic compression of the right main bronchi at the carina level. In the second patient, the image demonstrates an invasion of the carina coupled with destruction of the cartilage of the right main bronchi. Finally, in the third patient, the bronchoscopy images reveal a case of bronchoesophageal fistula at the level of the carina and right main bronchus (Figures 1 to 4). A Y-stent was inserted under direct vision in all three patients to palliate their symptoms.