Abstract Introduction Cavitary lung lesions frequently pose diagnostic and treatment dilemmas. Most commonly associated with necrotizing lung infection, or lung abscess, they are also frequently associated with malignant lung lesions which may also have superimposed infection.1,2 When a lung abscess persists despite several weeks of appropriate antimicrobial coverage, bronchoscopy is often considered for in-depth infection workup, tissue diagnosis, and, infrequently, cavity drainage.3 Case We present a case of a 62 year-old female patient with a history of asthma, and post-intubation tracheal stenosis who was referred to interventional pulmonary for bilateral lower lobe cavitary lung lesions that had persisted despite several courses of amoxicillin-clavulanate over an 18-month period. Six months prior, a bronchoscopy found inflammatory tissue on pathology and grew streptococcus mitis and parasanguinis from the left and streptococcus salvarius/epidermitis from the right on tissue culture. All streptococcus species were oxacillin sensitive. Repeat imaging revealed worsening 4.9cm right lower lobe (RLL) lesion and 6.7cm left lower lobe lesion (LLL). The patient underwent a ION robot-assisted navigational bronchoscopy. The RLL lesion was localized and pus was aspirated with a 19G needle. The robotic catheter (2.0mm Inner Diameter) was advanced to the dependent area of the lesions and connected to an in-line suction which aspirated 50ml of purulent fluid. Cryobiopsy was performed with 1.1mm cryoprobe. An intra-procedural one beam CT showed a real-time decrease in lesion size of approximately 30-40%. The LLL lesion was then localized with rEBUS and the catheter position was fine-tuned with cone-beam CT. Another 50ml of purulent fluid was drained in the same manner. Surgical pathology showed inflammation and culture again grew pan-sensitive strep. salvarius. Discussion Bronchoscopic drainage of antibiotic-resistant lung abscess has been well described, however this appears to be the first case in which the 2.0mm blunt catheter was used to successfully drain an abscess. Previously described endoscopic techniques include needle drainage, pigtail placement, and instillation of DNAse.4-8 Since our method only uses the bronchoscopy catheter, this method carries a theoretically lower risk of complications such as pneumothorax or bleeding. Additionally, the flexibility of the robotic catheter allows for access to otherwise difficult-to-reach lung regions. Overall this method appears to be a safe and effective treatment for an antibiotic resistant pyogenic lung abscess. This abstract is funded by: none
Friedman et al. (Fri,) studied this question.