A Rare Presentation of Pneumonic-Type Adenocarcinoma Hidden behind Empyema

Area of Science:

• Pulmonology
• Oncology
• Radiology

Background:

• Pneumonic-type adenocarcinoma (P-ADC) presents a diagnostic challenge due to its radiographic similarity to pneumonia.
• Distinguishing P-ADC from infectious pneumonia is critical for appropriate patient management.

Observation:

• A 50-year-old male initially diagnosed with pneumonia, pulmonary abscess, and empyema showed clinical and laboratory improvement with standard treatment.
• Despite initial improvement, serial chest computed tomography revealed an enlarging infiltrative shadow, suggesting an unresolved or progressive underlying pathology.

Findings:

• Bronchoscopy confirmed the presence of adenocarcinoma in the patient with the enlarging infiltrative shadow.
• The case illustrates a P-ADC initially misdiagnosed as pneumonia that progressed to abscess and empyema.

Implications:

• This case underscores the necessity of including P-ADC in the differential diagnosis for persistent or enlarging pneumonia-like lung opacities, especially after empyema treatment.
• Prompt diagnostic procedures, such as bronchoscopy, are vital for accurate diagnosis and timely initiation of oncological treatment in suspected P-ADC cases.