Bronchoscopic Direct Drainage of a Treatment-Resistant Lung Abscess via Endoscopic Balloon Dilation in a High-Risk Patient.

A 49-year-old man presented with a cough, hemoptysis and fever. Computed tomography revealed a lung abscess in the right upper lobe. The patient's medical history included chronic renal failure with haemodialysis, myocardial infarction and developmental disorders. On admission, he was administered piperacillin/tazobactam and minocycline, but they were ineffective. Bronchoscopy was performed with a guide sheath to drain the abscess, but complete drainage could not be achieved. Percutaneous transthoracic drainage or surgical resection were not indicated because of complications, so direct endoscopic balloon dilation was performed on the narrowed bronchus communicating with the abscess cavity. This treatment resulted in spontaneous drainage of the abscess, allowing the ultra-thin bronchoscope to access the cavity and achieve complete drainage. The abscess subsequently decreased in size. Bronchoscopic direct drainage after balloon dilation can be a viable treatment option in patients with a treatment-resistant abscess and severe comorbidities who are ineligible for invasive procedures.