Photodynamic therapy for synchronous occult bronchial cancer 17 years after pneumonectomy

We present a patient with radiologically occult double synchronous bronchial neoplastic lesions 17 years after right pneumonectomy. Chest radiograph and CT scan of the thorax showed no abnormalities of the residual lung fields nor mediastinal lymphadenopathy. Standard white light bronchoscopy (WLB) revealed a tumour in the left lower lobe bronchus. Autofluorescence bronchoscopy (AFB) indicated two abnormal fluorescing areas; one in the left lower lobe (as per WLB) and the other in the right lower lateral wall of the trachea. Both of these proved to be neoplastic. The two lesions were treated by bronchoscopic photodynamic therapy (PDT) with complete response so far for 10 months. AFB played a crucial role in diagnosis and ensuring completeness of treatment by PDT in this case with encouraging early results illustrating the respective value of AFB and PDT in such cases.