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. Themajority 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 topsthe list of all causes of cancer-related deaths globally and is ahead of digestive tract malignancies. Small-celllung 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, systemicnature, and poor response to available treatment options. “sunray sign” in chest radiographs is first describedin literature and constitutes a hilar mass or radiopacity with inhomogeneous linear opacities spreading towardthe periphery like sunrays, which is a marker of interstitial lymphatic involvement due to malignant spread ofdisease. The “sunray sign” is an indicator of underlying lung malignancy with central airway or main stem bronchusinvolvement and lymphatic dissemination in linear opacities. In this case report, we have reported a 51-year-oldmale who presented with cough and hemoptysis with progressive worsening of shortness of breath. Chest X-raysdocumented round opacities occupying the right hilum with linear opacities emerging toward the periphery in lungparenchyma, showing the typical “sunray sign.” Bronchoscopy was done after clinical stabilization and showedendobronchial 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 “smallcell histological type” lung malignancy for the “sunray sign” in our case. A high index of suspicion is a must to ruleout underlying malignancy, and bronchoscopy is the “gold standard” test in cases with the sunray sign to confirmthe diagnosis.