A case of lung abscess mimicking lung cancer

Abstract

The radiological appearance of lung abscess is nonspecific and can masquerade as a mass lesion during the early phase. The treatment is primarily medical, but surgical treatment is necessary when the size is larger than 6 cm and when patients show any indications of massive hemoptysis, empyema, bronchial obstruction, and risk of cancer or when the medical treatment fails. A 55-year male patient presented with complaints of back pain over a period of two years with additional complaints such as fatigue and coughing up of blood. On physical examination, crackles in the right upper zone of his lungs were observed. Chest x-ray revealed a cavitary lesion in the right upper zone. The patient was taken to the hospital with preliminary diagnosis of lung cancer. A fiberoptic bronchoscopy (FOB) was performed resulting in a preliminary diagnosis of malignancy. No endobronchial lesion was detected in FOB. The bronchoalveolar lavage (BAL) culture was negative. The BAL cytology was also benign. As a result, oral levofloxacin treatment was started. During follow-up examination, a partial reduction in the size of cavity was observed. As a result of this observation, PET-CT was ordered. According to the results, 18F-fluorodeoxyglucose (FDG) uptake of the level (maximum standardised uptake value [SUVmax]: 10.9) suspicious for malignancy was noted in the right hilar lymph node associated with irregular lobulated mass, which was considered to be associated with the pleura in the posterior segment of the right upper lobe. The patient was taken for surgery in light of these findings. The pathological results were consistent with abscess. The patient has no complaints six months after the surgical operation.