Lung Cancer on Left Tracheal Bronchus in A Patient with Situs Inversus Totalis
Rodriguez Perez Hugo1, Diaz Soriano Sofia2, Ruiz Tarbet Clara Elisa2, Pulido Hernandez Idalays2 and Rodrigo Garzon Manuel2*
1Intensive Care Unit, Insular University Hospital, Spain
2Pulmonology Service, Insular University Hospital, Spain
Submission: May 22, 2023; Published: June 08, 2023
*Corresponding author: Manuel Rodrigo Garzon, Pulmonology Service, Insular University Hospital, Avenida Maritima s/n, 35016, Las Palmas GC, Spain
How to cite this article: Rodriguez Perez H, Diaz Soriano S, Ruiz Tarbet Clara E, Pulido Hernandez I, Rodrigo Garzon M. Lung Cancer on Left Tracheal Bronchus in A Patient with Situs Inversus Totalis. Int J Pul & Res Sci. 2023; 6(4): 555693. DOI: 10.19080/IJOPRS.2022.06.555693
Abstract
Keywords: Situs inversus; Tracheal bronchus; Lung cancer
Abbreviations: TB: Tracheal Bronchus; SIT: Situs Inversus Totalis
Clinical Case
This article presents the case of a non-small cell lung cancer on a left tracheal bronchus (TB) in a 56 year old man with visceral total inversion. To our knowledge this case is the first report of a patient with the three circumstances at the same time. Finally, we discuss a review of cases found in worldwide literature.
Case Details
A 56 year old man, long-term smoker (54 pack-years) with a personal history of high blood pressure, spontaneous pneumothorax at the age of 14 and a congenital visceral situs inversus with transposition of bowels. His only treatment was valsartan 80mg once a day. He was referred because of a two month involuntary weight loss (approximately 12kg), edema and facial congestion. A thorax scan was taken which showed a heterogeneous neoplastic mass in the left apex of approximately 8x10x9cm which was dependent on a left tracheal bronchus (Figure 1A), with mediastinal and vascular invasion of superior vena cava, left upper pulmonary vein and artery.
After these findings a flexible bronchoscopy was performed that showed a situs inversus of the patient’s airways with a left tracheal bronchus in the left distal wall of the trachea which was completely obstructed by an endobronchial mass (Figure 1B). Endobronchial brushings and biopsies revealed a poorly differentiated non-small cell carcinoma compatible with lung adenocarcinoma. Genetic testing revealed positive EGFR mutation. The final stage was IV and after multidisciplinary discussion the patient received treatment with radiotherapy and chemotherapy until he died two years later due to tumoral progression.
Discussion
The presence of TB usually is an incidental finding on a bronchoscopy or in a CT scan and it does not require any specific treatment. Its incidence varies from 0.5 to 1%. The defect in the embryogenesis that results in this disorder is still uncertain. These are also known as “pig bronchus” due to the fact that it is common to find them in these animals. In humans this normally has a right prevalence and usually corresponds to the apical segment of the right upper lobe although sometimes can correspond to a real supernumerary bronchus. This bronchus can end in lung tissue or in a blind pouch. They are usually found within 2cm of the main carina but can be located in any position between the cricoid cartilage and the main carina. It can also be bilateral or double at presentation. Occasionally, they can produce atelectasis, hemoptysis and pneumonia [1], but the presence of lung cancer within this anomaly is very uncommon [2-4].
On the other hand, situs inversus totalis (SIT) is a condition in which the body organs are located in a mirror image from their normal position. This occurs in one between 10.000 and their life expectancy is normal [5]. The clinical association of SIT and lung cancer in the same patient has been described previously [6,7] but there are very few reports of the coincidence of SIT with TB [8]. In our patient the SIT was already diagnosed, and the left TB was discovered in the CT scan and was confirmed during the bronchoscopy. Knowledge of these congenital variations can be of interest in the case of surgery, intubation and bronchoscopy. This case presents a left TB, a SIT and lung cancer in this TB at the same time. Reviewing scientific literature, we have not found any other patient with the same conditions, and for this reason we find it of high interest to publish.
References
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