CRA60 RIGHT LUNG COLLAPSE MASKING LUNG MALIGNANCY: A CASE REPORT

Prisaana Ramakrishnan1, Ian Victor Sooriyaghandan1, Larry Ellee Nyanti2,3, Shah Min Lo2, Nai Chien Huan2, Hema Yamini Devi Ramarmuty2, Kunji Kannan Sivaraman Kannan2
Affiliations
1Department of Internal Medicine, Queen Elizabeth Hospital, Kota Kinabalu.
2Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu.
3Medical Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah.

Introduction

Right lung collapse has distinctive features but can be missed if it is subtle. Collapse is usually secondary to bronchial obstruction and must be investigated promptly. This case report highlights a challenging scenario of a patient presenting with right lower lobe collapse and eventually diagnosed with primary lung malignancy. 

Case Report

A 48-year-old male active smoker presented with blood-stained productive cough-since March 2022. A chest radiograph (CXR) revealed right lower lobe collapse and blunted right costophrenic angle. No thoracocentesis was performed, and he was discharged with macrolides. Smear for acid-fast bacilli was negative however the preliminary mycobacterium culture revealed 1+ isolate growth. Anti-tuberculous therapy (ATT) was commenced on that basis. He was admitted for respiratory distress and a repeated CXR revealed a right lower lobe collapse with tracheal deviation to the right. Computed tomography angiography (CTA) thorax demonstrated a large middle lobe mediastinal mass. The final sputum culture did not yield mycobacterium tuberculosis. Bronchoscopic biopsy confirmed keratinizing squamous cell carcinoma. However, the patient succumbed at the intensive care unit. 

Conclusion

This case is a reminder to clinicians on the importance of investigating right lower lobe collapse, tracing of mycobacterium identification and ensuring continued monitoring of response following commencement of ATT as it may mask lung malignancy.