Two Cases of Lung Cancer With Unilateral Lung Atelectasis Caused by Carinal Invasion Treated by Transbronchial Therapy

Abstract

Purpose. We report two cases of lung cancer with carinal invasion and atelectasis of one lung. The indications of intra-bronchial therapy are also discussed. Case 1. A 67-year-old man had a polypoid tumor (small cell lung cancer, intermediate type) in the left main bronchus invading the carina with left lung atelectasis. The tumor was resected by intra-bronchial electrocautery, followed by radiation therapy. Recurrence was not observed 3 months later. Case 2. A 73-year-old man had an adenocarcinoma invading the carina and both main bronchi with left lung atelectasis and bilateral pneumonia. Although we chose radiation therapy because of the high intraoperative risk of stenting, the stenosis of the right main bronchus progressed despite radiation therapy. Therefore we performed intrabronchial stenting for the right main bronchus, but the patient died one week later. Conclusion. Atelectasis of one lung due to lung cancer sometimes improves by irradiation or chemotherapy. However, the situation of patients with lung cancer invading the carina with atelectasis of one lung is different from that of simple atelectasis of one lung, because those patients have a high possibility stenosis of the contralateral main bronchus occuring during treatment. In those cases, prompt resolution of the lung atelectasis by intrabronchial treatment is essential, even if there is considerable intraoperative risk.