A 63-year-old male patient with a history of chronic smoking, with no other morbid history.
She presented with pain in the left hemithorax of 3 weeks duration, associated with an unquantified weight loss and a sensitive volume increase in relation to the left pectoral muscle.
The chest X-ray showed an opacity of poorly defined borders in the left perihilar region.
A chest CT scan was requested, which showed a tumor of 6.3 per 5.8 cm in the left upper pulmonary lobe (long film Figure 1B) with extensive involvement of the anterior chest wall, with no signs of ipsilateral adenovascular invasion or compromise of structures
With these findings, a fibrobronchoscopy was performed, which showed mild thickening of the carina septate and upper left lobe, without intraoral lesions.
Three transbronchial samples were taken and biopsy was reported as nonspecific chronic bronchitis with incomplete squamous metaplasia.
He was admitted to hospital to complete his study evolving with persistent pain in relation to the tumor mass, without fever and stable hemodynamics.
Laboratory tests revealed anemia (hemoglobin 9.5 g/dl), thrombocytosis (776,000 /mm3) and leukocytosis with left shift (42,600/mm3 with 37% of bacilliforms).
Myelogram showed myeloid hyperplasia compatible with a reactive medulla without constituting a neoplasm.
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Percutaneous puncture was performed by interventional radiology that gave rise to purulent content, whose aerobic bacterial culture was negative.
A surgical drainage of the abscess, cleaning and debridement of the devitalized tissue were performed due to suspicion of rib wall tumor.
A sample of the chest wall was taken for biopsy and an aspiration system was installed for wound closure.
The biopsy was informed as a chest wall infection with involvement of the skin, subcutaneous tissue, pectoral muscle and peristaltic rib without malignant histological elements.
The infectology team evaluated antibiotic treatment with penicillin G IV for 2 weeks.
The patient presented good general conditions, with regression of inflammatory parameters and decreased drainage output.
Three weeks after the operation, the last surgical clean-up and definitive closure of the wound were performed.
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She was discharged with amoxicillin for three months.
The patient was kept in outpatient follow-up, with no evidence of complications, and radiological follow-up at seven months postoperatively showed complete regression of the lesion.
