Abstract Introduction Lung cancer remains the leading cause of cancer related mortality in the United States accounting for an estimated 127,070 deaths per year. Squamous cell carcinoma (SCC) is a type of non-small cell lung cancer (NSLCS) that most commonly arises in the central airway, typically involving the main bronchi. Patients with advanced disease are at an increased risk of developing infectious complications, including lung abscess and empyema, both of which are associated with significant morbidity and can complicate cancer management. Herein we present a case of lung abscess complicating SCC that was treated with endobronchial drainage using Endobronchial Ultrasound (EBUS). Case Report A 41-year-old male with Stage III right hilar squamous lung cancer presented to the emergency department with chest pain, cough, and chills. His past oncologic history included endobronchial stent; concurrent chemoradiation; and ongoing maintenance durvalumab immunotherapy. He also had a history of recurrent Pseudomonas aeruginosa pneumonia. Chest radiograph and CT scan demonstrated increase in the size of known right upper lobe lung mass with new cavitary component concerning for abscess, with worsening bronchial obstruction. The patient was initiated on intravenous meropenem and subsequently underwent bronchoscopy, which revealed complete obstruction of the right mainstem bronchus. EBUS needle aspiration of the right upper lobe lung abscess was done with subsequent copious purulent drainage along with right main stem bronchus balloon dilation. He was monitored in the intensive care unit. Fine needle aspiration cultures showed methicillin sensitive Staphylococcus aureus (MSSA) and Pseudomonas aeruginosa. Figure 1. CT Chest without contrast demonstrates right hilar malignancy with progressive increased opacification in the right upper lobe with scattered gas-filled cystic spaces. Discussion Hilar squamous cell lung cancer commonly presents with airway obstruction and post- obstructive pneumonia. Abscess formation in patients with advanced squamous cell lung cancer most often results from impaired bronchial drainage and reduced mucociliary clearance. These impairments are typically secondary to tumor cavitation, necrosis, or airway obstruction. Bronchoscopic interventions particularly with EBUS guidance have growing diagnostic and therapeutic indications including cancer related lung abscess microbiology sampling and drainage. This abstract is funded by: None
Elaksher et al. (Fri,) studied this question.
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