Dear Editor,

Jaundice, which can be caused by a very wide variety of conditions, results from the increased levels of bilirubin in the blood. Due to the affinity of bilirubin to elastin, jaundice is best detected by examining the skin and sclera, but can also be found in others elastin-rich tissues such as skin, sclera, intima of the vessel wall and ligaments.

We present the case of a 68-year-old nonsmoker male who was referred to the emergency department for evaluation of 1-week history of jaundice, light-colored stools, dark urine, anorexia and weight loss. Blood work showed an elevated direct bilirubin 9.34 mg/dL (normal, 0–1 mg/dL) and he was diagnosed with a carcinoma of the pancreas head.

Bronchoscopy was performed during a pulmonary nodule investigation and revealed a nodule on the left side of the epiglottis and severe vocal cords and bronchial tree jaundice (Fig. 1).

Fig. 1. (A) Epiglottis; (B) Vocal cords; (C) Carina; (D) Truncus intermedius.

Bronchoscopy is not a frequently performed exam in patients with such high levels of bilirubin in the blood. In the present case bronchoscopy was performed due to the nodule location, making it difficult to access through transthoracic lung biopsy and due to the need for pulmonary metastasis exclusion in order to get a correct staging.

The high amount of elastin present in the airways makes it possible to observe a fine yellow coloration characteristic of jaundice in the bronchial tree, as observed in these endoscopic images of rare beauty and iconographic interest.

The authors have no conflicts of interest to declare.

Corresponding author. ana_f_goncalves@hotmail.com