Sunray sign in chest radiograph: A marker of central airway lung malignancy!

Abstract

Lung cancer is usually diagnosed in the late stage due to a lack of awareness of symptoms to patient, lack of widespread screening practices, and lack of sensitization to the most common radiological signs of lung malignancy to family physicians. Radiological signs will help in suspecting lung cancer earliest and important role in guiding a protocolized workup to rule out underlying malignancy. “Sunray sign” in chest radiograph is first time described in the literature and constitutes hilar mass or radiopacity with inhomogeneous linear opacities spreading toward the peripheries like sunrays, which is a marker of interstitial lymphatic involvement due to the malignant spread of the disease. “Sunray sign” is an indicator of underlying lung malignancy with central airway or mainstem bronchus involvement with lymphatic dissemination in linear opacities. In this case report, we have reported a 59-year-old male presented with cough and hemoptysis with progressive worsening of shortness of breath. The chest X-ray documented round opacity occupying the right hilum with linear opacities emerging toward the peripheries in the lung parenchyma showing typical “sunray sign.” Bronchoscopy was done after clinical stabilization and showed endobronchial polypoidal growth in the right intermediate bronchus causing partial occlusion of the bronchial lumen. Endobronchial needle aspiration cytology and punch or forcep biopsy (FB) histopathology were suggestive of a “squamous cell” type of lung malignancy for “sunray sign” in our case. A high index of suspicion is a must to rule out underlying malignancy, and bronchoscopy is the “gold-standard” test in cases with sunray sign to confirm diagnosis.

Keywords

• bronchoscopy
• chest radiograph
• endobronchial needle aspiration cytology
• squamous cell carcinoma
• sunray sign