A80-3-47 Hemoptysis and Ground Glass Opacity: An Unexpected Diagnosis of Lung Cancer in a Young Male

Abstract Introduction Lung cancer is the second most common cancer in men, with diagnosis under 40 years of age being relatively uncommon. Here we discuss the diagnostic challenges involved in a young patient presenting with hemoptysis, who was found to have rapidly progressive adenocarcinoma of the lung. Description A 38-year-old African American male with a prior history of treated blastomycosis of the left lung, was admitted to our hospital for evaluation of intermittent hemoptysis, that started a few weeks prior. He had a 10-pack-year smoking history and was previously incarcerated. On admission, his vital signs and physical examination were unremarkable. Computed Tomography (CT) pulmonary angiogram showed a right upper lobe ground glass opacity measuring 5 cm in size with adjacent posterior right apical pleural thickening, which was suggestive of an infectious process or pulmonary hemorrhage. He subsequently underwent bronchoscopy with bronchoalveolar lavage (BAL) with unremarkable results, including culture data and cytology. Due to persistence of his symptoms, a transbronchial cryobiopsy of the right upper lobe lesion was performed, which was concerning for adenocarcinoma. Endobronchial ultrasound (EBUS) was negative for right hilar and mediastinal involvement. Positron Emission Tomography-Computed Tomography (PET-CT) was suggestive of a primary lung malignancy in the right upper lobe with right supraclavicular lymphadenopathy, extensive right pleural involvement, and malignant pleural effusion. He was initiated on weekly chemotherapy and palliative radiotherapy for bone and pleural metastasis and showed marked interval response to therapy. Discussion Non-small cell lung cancer (NSCLC), especially adenocarcinoma, can present as an infectious or inflammatory process, especially in younger individuals. This causes diagnostic challenges and as a result, these patients are usually diagnosed at an advanced stage of cancer with increased rates of mortality. Our patient presented with hemoptysis as the sole manifestation, with imaging that showed a right upper lobe ground glass opacity. Given his age and previous history of blastomycosis, a recurrence of infection was high in the differential diagnosis, with very low suspicion for malignancy. Moreover, initial bronchoscopy with BAL was unremarkable for infectious etiology and had negative cytological examination. The persistence of symptoms including hemoptysis led to further evaluation, including a transbronchial cryobiopsy that revealed the diagnosis. This case emphasizes the need for vigilance and additional testing in young patients presenting with atypical features, as an early diagnosis of lung cancer can improve their survival rates and overall prognosis. This abstract is funded by: None