Minor pneumothorax was indicated by CT after 2 days, but the patient did not exhibit dyspnea nor require oxygen administration at rest. The patient was discharged 3 days after RFA. Fig. 1 The patient was a 67-year-old man. A 23-mm tumor inhibitor Ponatinib is apparent in the superior segment of the right lower lobe (S6) on CT performed during RFA. Usual interstitial pneumonia with reticular and ground-glass opacities is evident in both inferior lobes Chest X-ray and clinical follow-up after discharge, 2 weeks after RFA, revealed no pneumothorax requiring evacuation, dyspnea on exertion or other respiratory symptoms. Pulmonary rehabilitation was restarted as an outpatient basis. Progression of pneumothorax was evident on CT performed at 4 weeks after RFA. The patient was rehospitalized for aspiration via a 4 Fr chest tube.
Pneumothorax improved, but the patient complained of back pain, and the tube was removed 5 weeks after RFA and continued administration of the antibiotic. Symptoms improved for 4 weeks, but the fever and back pain reappeared and elevated C-reactive protein and white blood cell count were observed. CT showed pleural effusion with an air-fluid level 12 weeks after RFA. Therefore, video-assisted thoracoscopic debridement of empyema and drainage were performed 13 weeks after RFA (Fig. 2). Necrosis of the S6 tumor was confirmed during the procedure. 24Fr conventional double lumen drain and 19Fr silastic flexible drain (BLAKE silicone drain; Ethicon, Somerville, NJ, USA) were inserted. Exudative pleural effusion cytology and cell culture tests were both negative.
Because the control of air leak was poor even with debridement and drainage, 4 mL of a tissue adhesive (Bolheal, Kaketsuken, Kumamoto, Japan) and two times of autologous blood were administered. The air leak and fever finally subsided 24 weeks after RFA, and the drain was removed. Even though evidence of pleural effusion and pneumothorax was still detectable on CT, the patient did not present associated symptoms and was discharged 7 months after RFA. Follow-up CT at 11 months after RFA showed no signs of pleural effusion, though pneumothorax was still detected. No local recurrence or metastasis of the RFA-treated tumor was seen. Fig. 2 Severe pneumothorax and empyema are seen in the right lung. Debridement of empyema and pleural drain placement were performed by video-assisted thoracoscopy Discussion The treatment of lung cancer with interstitial pneumonia remains a challenge.
The presence of interstitial pneumonia is a risk factor for development Carfilzomib of drug-induced pneumonia, which is most notably associated with the anticancer agents used in chemotherapy. Surgery also poses a risk of acute postoperative exacerbation of interstitial pneumonia, as the level of cytokines increases after invasive surgery (1, 2). Radiotherapy also carries a risk of radiation pneumonitis and is contraindicated in patients with interstitial pneumonia.