Metastatic lung cancer presenting as thoracic empyema. A Case report.

Andrea Leporati,Ugo Cioffi,Federico Raveglia,Filippo Ghelma,Alessandro Baisi,Matilde De Simone

doi:10.1002/ccr3.2566

Andrea Leporati, Ugo Cioffi + Show 4 more

Open Access

https://doi.org/10.1002/ccr3.2566

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Journal: Clinical case reports	Publication Date: Feb 5, 2020
Citations: 1	License type: CC BY 4.0

Affiliation: Ospedale San Paolo, University of Milan

Abstract

Increased cancer risk in patients with inflammatory and infectious diseases has been reported in many studies and lung cancer‐associated empyema in <0.3% patients. We present a patient with empyema in whom the final diagnosis was metastatic lung adenocarcinoma. Purulent pleural fluid obtained by drainage or thoracentesis must always been examined because the association of malignant tumors and empyema should be taken into consideration.

Highlights

We describe the case of a patient with empyema in whom the final pathology result was metastatic adenocarcinoma of the lung
The patient subjected to video-assisted thoracoscopy: At surgery, a massive parietal and visceral pleural thickening was found with the trapped lung
Physicians must be aware of a possible presence of cancer when patients with empyema are refractory to standard treatment

Summary

| INTRODUCTION

The incidence of pleural empyema as a primary finding in lung cancer patients is low (0.1%-0.3%), and only a few references on its management and outcome are reported in the literature.[1]. She smoked 30 cigarettes per day for 40 years. Chest radiographs revealed complete atelectasis of left lung with signs of mediastinal shift (Figure 1). A chest CT scan confirmed a left pleural thickening with mixed high-density pleural fluid and collapsed lung (Figure 2). A chest tube was placed into the pleural space with evacuation of 1000 cc of dark-colored purulent liquid. The respiratory symptoms and vomiting improved, but a daily evacuation of 200/300 cc of pleural fluid persisted. Chest CT scan showed reduction of pleural effusion with persistent atelectasis of lower left lobe and diffuse pleural thickening (Figure 3). The patient subjected to video-assisted thoracoscopy: At surgery, a massive parietal and visceral pleural thickening was found with the trapped lung.

Findings

| CONCLUSION

| DISCUSSION