Massive hemoptysis: an unusual presentation of papillary thyroid carcinoma due to tracheal invasion

A 67-year-man presented to the emergency department with massive hemoptysis, coughing up about 250mL frank blood in 2-3hours. Physical examination was significant for tachycardia, tachypnea and blood around the mouth. A CT of the chest did not reveal any aetiology of hemoptysis. Flexible fiberoptic bronchoscopy was remarkable for an actively oozing 1x1cm sessile subglottic polyp on the anterior tracheal wall. CT neck revealed a 2.5x2.4cm pretracheal soft tissue mass, bulging into the subglottic trachea. Fine needle aspiration confirmed papillary thyroid carcinoma with BRAF mutation. The patient underwent radical resection and surgical pathology confirmed a 2.5cm papillary thyroid carcinoma with extensive extra-thyroid extension into the tracheal mucosa. Invasion of the trachea and surrounding structures like larynx and oesophagus is not usual for papillary thyroid carcinoma and may be associated with aggressive cancer behaviour and relatively poor outcome and prognosis.