We report the case of a 63 year old male diagnosed with lung cancer adenocarcinoma with EBUS-TBNA 22G needle. The patient had a right paratracheal mass diagnosed with EBUS-TBNA 22G (Fig. 1, Fig. 2.). The patient had surgery a right pneumonetctomy, however after 7 days when the billau catheter was removed pneumothorax was diagnosed which did not resolved. Bronchoscopy reveled two minor fistulas in the interior wall of the trachea (Fig. 3.). An additional surgery was performed in order to add a muscle flap patch on the exterior part of the trachea (Fig. 4.). Unfortunately additional stent placement was placed after a silicon stent since the muscle patches failed (Fig. 5.). We chose finally a metallic auto expandable stent since after three months of follow up a small metastatic lesion was observed in the liver (Fig. 6, Fig. 7.). Stent placement is an option for these patients and the right stent has to be placed for each case. After one year of follow up small granulomas have been observed in parts of the stents, however without local cancer recurrence. The patient had a biopsy of the initial metastatic liver lesion and with PD-L1 expression 90% is under immunotherapy with pembrolisumab for 9 months with complete disease control (see Fig. 8).
Lung mass right upper lobe with PET-CT.