Abstract Introduction Lung adenocarcinoma can present with atypical complications such as necrotizing pneumonia, empyema, and persistent pneumothorax, which may confound diagnosis and complicate management. This case highlights the challenges faced in diagnosing and treating a patient with an underlying malignancy masked by infectious and structural pulmonary complications. Case A 72-year-old male with a significant smoking history (30 pack years), hypertension, anxiety, and substance use disorder (on methadone) was admitted to Lincoln Hospital with worsening shortness of breath and weakness. Imaging revealed a right hilar mass, extensive necrotizing pneumonia, and pleural effusion. Given the complexity of the presentation, a pigtail catheter was inserted for drainage of the pneumothorax, which yielded 200 cc of purulent fluid. Pleural fluid analysis revealed Streptococcus intermedius but was negative for malignancy and chylothorax. The patient was initially treated with intravenous antibiotics with improvement. Despite this, the patient’s developed pneumothorax due a presence of bronchopleural fistula, and he was transferred to a tertiary care center for further management. At the tertiary center, the patient underwent a right thoracotomy with serratus muscle flap harvest and inset, decortication, pleurectomy, and marsupialization of an abscess cavity. Pathology from the decortication and pleural rind samples confirmed the presence of invasive adenocarcinoma of the lung. Immunohistochemical markers, including TTF-1 and BerEP4, were positive, supporting a diagnosis of lung adenocarcinoma, Discussion This case underscores the importance of considering malignancy in patients with severe pulmonary infections and structural complications. The diagnosis of lung adenocarcinoma was initially obscured by the presentation of necrotizing pneumonia and empyema, leading to a prolonged and complex treatment course. The presence of a bronchopleural fistula and persistent pneumothorax complicated surgical management, requiring a multidisciplinary approach involving infectious disease, pulmonology, thoracic surgery, and oncology. Conclusion Lung adenocarcinoma, when complicated by necrotizing pneumonia, empyema, and bronchopleural fistula, presents significant diagnostic and therapeutic challenges. This case highlights the critical need for a high index of suspicion for malignancy in patients with such complex pulmonary presentations. Early detection and targeted therapy may improve outcomes in this high-risk patient population. This abstract is funded by: None
Gazineo et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: