Pulmonary infections imitating lung cancer: clinical presentation and therapeutical approach

Pulmonary infections occasionally present with infectious pseudotumour of the lung not easily distinguishable from true pulmonary neoplasm. In such cases, radiographic findings and clinical manifestation are highly suggestive of lung cancer. These inflammatory lung lesions cause significant diagnostic problems and appropriate therapy is often considerably delayed. We therefore report on our experience with infectious pseudotumour of the lung caused by bacterial, mycobacterial and fungal pulmonary infections.

In a retrospective case series, patients with lung infections simulating pulmonary carcinoma were identified. Clinical presentation, radiological features, surgical procedures and outcome were analysed.

There were seven male and six female patients with a mean age of 53 years. Presumed pulmonary carcinoma and hemoptysis were main reasons for hospital admission. Procedures performed were video-assisted thoracoscopic wedge resection (6), lobectomy (5), video-assisted thoracoscopic lobectomy and open wedge resection each in one case. Pathologic examination of the obtained specimens revealed tuberculoma (5), aspergilloma (3), pulmonary actinomycosis related pseudotumour (3) and coccidioidoma (2). Following definite diagnosis, patients with tuberculosis and fungal infections received antituberculotic and antifungal medications, respectively. Patients suffering from pulmonary actinomycosis received penicillin. There was no in-hospital mortality. One re-thoracotomy was mandatory because of pleural empyema.

Pulmonary infections simulating lung cancer require surgical removal both for establishing definite diagnosis and to manage complications like haemoptysis and ongoing contamination of the airways by infectious agents. Whenever feasible, limited thoracoscopic resections are preferable. Following definite diagnosis antimicrobial drug therapy for a sufficient length of time is mandatory.