CRA38 SQUAMOUS CELL LUNG CARCINOMA PRESENTING AS PULMONARY ABSCESS: A DIAGNOSTIC CHALLENGE

Muhamad Aqil Gibran¹Sabrina Ermayanti,¹Afriani Afriani,²

¹Departement of Pulmonology and Respiratory Medicine, Faculty of Medicine,Andalas University, Padang West Sumatra, Indonesia
²Departement of Pulmonology and Respiratory Medicine, Dr. M. Djamil General Hospital, Padang, West Sumatra, Indonesia

Introduction
Lung squamous cell carcinoma (LSCC) may manifest as cavitary lesions in 10–22% of cases. These cavitations are prone to secondary infection, potentially progressing into pulmonary abscesses. This condition may lead to delayed diagnosis and postponed initiation of appropriate cancer treatment.

Case Report
A 54 year old smoker was admitted because of productive cough with abundant expectoration, fever, weight loss and Diabetes Mellitus. Chest CT revealed a central mass in the right lung. Thoracic ultrasonography demonstrated hypoechoic lesion with internal calcified foci that typical of abscess formation. Thoracentesis was done and pus was obtained. Antibiotics were administered according to the culture results Staphylococcus Aureus, however the patient's condition improved. A post-thoracentesis chest X-ray following antibiotic treatment revealed a cavitary lesion with an air-fluid level, raising concern for a lung abscess. Bronchoscopy demonstrated an invasive mass in the right lower lobe, and a forceps biopsy was performed. Histopathologic examination confirmed a diagnosis of LSCC

Discussion
Cavitating SCC may be radiologically mistaken for pulmonary abscesses. Cavitation in LSCC typically results from central tumor necrosis secondary to rapid tumor growth that outpaces its blood supply, leading to the formation of air-filled cystic spaces. These cavities may become secondarily infected, forming true abscesses. Further diagnostic evaluation is essential in such cases. Bronchoscopy subsequently confirmed SCC. Malignancy should be considered early to prevent delays in cancer treatment

Conclusion
Cavitating lung lesions pose a diagnostic challenge due to their similarity to pulmonary abscesses. In high-risk patients, malignancy should be considered early, with prompt confirmation through bronchoscopy and biopsy to avoid delays in treatment.