Procedures: Procedures: Bronchology |

Bronchoscopic Drainage of Endobronchial Abscess FREE TO VIEW

Qiumei Wu, MMed; Alan Wei Keong Ng, MMed; Chuen Peng Lee, MMed
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Tan Tock Seng Hospital, Singapore, Singapore

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A428. doi:10.1016/j.chest.2016.02.446
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SESSION TITLE: Procedures: Bronchology

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA) have been utilised widely to obtain tissue diagnosis of mediastinal lesions. However, there has been no report of TBNA drainage of endobronchial abscess to our knowledge. We report a case of bronchoscopic drainage of endobronchial abscess with relieve of airway obstruction and radiological improvement of infective focus.

CASE PRESENTATION: A 48 year-old gentleman with a history of retroviral disease and multiple opportunistic infections, presented with cough and hemoptysis. Computed tomography (CT) thorax showed a cavitating lesion in the right middle lobe and soft tissue opacity surrounding and occluding the right main bronchus (RMB). Bronchoscopy revealed two opposing tumor-like masses emerging from the anterior and medial wall of the RMB causing 90 percent occlusion. Bronchial biopsies of the masses grew aspergillus fumigatus. Despite 6 weeks treatment with intravenous voriconazole, repeat bronchoscopy revealed minimal decrease in size of the masses with 80 percent occlusion of the RMB. Puncture of this lesion with a 19G needle resulted in free flow of purulent material and relief of the airway obstruction. A interval repeat CT showed a decrease in size of the cavitary lesion and improved aeration of the right lung.

DISCUSSION: Primary choice of treatment of aspergillosis is a protracted course of antifungals1. The duration of treatment is guided by the resolution of antigenemia, clinical and radiological findings1. For our patient, the endobronchial tumor-like lesions is caused by extensive pseudomembrane formation and polypoid granulation as a result of aspergillus pseudomembranous tracheobronchitis. The cavitatory lung lesion is a result of both primary infection and post-obstruction pneumonia. Treatment with voriconazole resulted in minimal radiological response. TBNA of the masses successfully relieved the obstruction of the right main bronchus, similar to incision and drainage of abscess, with marked radiological response. To our knowledge, there has been no report of TBNA drainage of endobronchial abscess to date, possibly due to the rarity of such lesions and advent of effective antibiotics. Drainage of endobronchial abscess allows for source control, relieves obstruction and prevents post-obstruction pneumonia. Risks involved includes spillage and tracking of pus into lower lobes, perforation and pneumothorax.

CONCLUSIONS: Bronchoscopic drainage of endobronchial abscess may serve as effective and safe method to relieve airway obstruction and facilitate treatment of post-obstruction pneumonia.

Reference #1: Thomas JW, Elias JA, David WD et al. Treatment of Aspergillosis: Clinical Practice Guidelines of the Infectious Diseases Society of America. Clin Infect Dis. (2008) 46(3):327-360. doi: 10.1086/525258

DISCLOSURE: The following authors have nothing to disclose: Qiumei Wu, Alan Wei Keong Ng, Chuen Peng Lee

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