Diffuse endobronchial metastasis from sigmoid carcinoma presenting as wheezing and respiratory failure

A 66-year-old Thai man with underlying asthma, history of traumatic right haemothorax, and sigmoid carcinoma with bladder invasion developed productive cough, whitish sputum, dyspnoea, and wheezing for 2 months. Physical examination showed generalized expiratory wheezing in both lungs. Computed tomography scan of the chest revealed diffuse thickening of bronchial wall, predominantly at lower lobes; several various sizes of pulmonary nodules; diffuse interlobular septal thickening; multiple enlarged mediastinal lymph nodes and hilar lymph nodes; and right pleural effusion. The patient was intubated for respiratory failure with persistent wheezing and, subsequently, with difficulty weaning from mechanical ventilation. Bronchoscopy was performed, which revealed diffuse multiple small mucosal nodules in both lungs. Pathology of the nodules showed foci of adenocarcinoma. Positive immunochemical staining with CDX2 confirmed the diagnosis of endobronchial metastasis of sigmoid carcinoma. This case highlighted a rare presentation of endobronchial metastasis from sigmoid carcinoma with persistent wheezing, respiratory failure, and difficulty in weaning from mechanical ventilation.