Thoracic empyema induced by transbronchial biopsy in two patients with lung cancer

Abstract

The development of thoracic empyema following lung abscess induced by transbronchial biopsy is a serious complication. Here, we report two cases of thoracic empyema induced by transbronchial biopsy. Case 1 was a 68-year-old man who developed thoracic empyema after transbronchial biopsy for squamous cell carcinoma of 47×34 mm in the left upper lobe with mediastinal lymph node metastases. His lung cancer was diagnosed as cT2aN2M0, Stage IIIA. After curettage under VATS (Video-assisted Thoracic Surgery) was unsuccessful, open window thoracostomy was performed for infection control. The post-operative course was satisfactory, and he began chemotherapy two months after open window thoracostomy. Case 2 was a 69-year-old man who had primary lung cancer of 58×48 mm in the lingular segment with no lymph node metastasis. Transbronchial biopsy revealed adenosquamous carcinoma. Then, he developed a high fever and dyspnea. Computed tomography of the chest 7 days after transbronchial biopsy showed a consolidation with an air- fluid level and pleural effusion in the left chest cavity. He underwent left upper lobectomy and curettage under VATS. The post-operative course was uneventful. In conclusion, surgical treatment is necessary for most patients with thoracic empyema following lung abscess induced by transbronchial lung biopsy, and so it is important to consider surgery.