CTICasesObstructing Squamous Cell Carcinoma with Distal Abscess, Drowned Lung, and Bronchopleural Fistula
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Imaging findings
The patient presented with opacification of the left hemithorax, volume loss, and aerated lung vessels, suggesting pleural effusion and probable left upper lobe collapse. A subsequent contrast CT showed a collapsed left upper lobe, soft tissue thickening along the mediastinal border and left hilum, and a rim-enhancing area with gas and liquid inside, consistent with an abscess cavity. Distally, there was a drowned lung. The origin of the left upper lobe bronchus was obliterated by soft tissue. Bronchoscopy confirmed occlusion of the left upper lobe bronchus by erythematous tissue, with inadvertent opening and spillage of pus from the abscess into the lungs. Subsequent imaging showed new gas collection possibly ruptured into the pleural space, seeding of the right upper lobe with pus, and then widespread pneumonia. The left upper lobe partially decompressed. A CT later showed the abscess cavity and communication with the pleural space (bronchopleural fistula).
Key takeaways
This case demonstrates complications of an obstructing tumor. Bronchoscopy in patients with obstructing endobronchial lesions and distal abscesses carries a risk of abscess rupture and aspiration of pus into healthy lung, which can be fatal. The biopsy of the area showed squamous cell carcinoma.
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