PMC7596337_01
Left CT of the thorax with the cancer lesion and endobronchial images, middle the radial-EBUS equipment, and right the ultrasound image from the cancer lesion with the radial-EBUS.
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A 65 year man was diagnosed with squamous cell carcinoma with radial-endobronchial ultrasound (R-EBUS) stage IV since he had bone metastasis (Fig. 1.).
CT of the thorax upon diagnosis.
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The patient was diagnosed with chronic obstructive pulmonary disease (COPD) stage III and he had severe emphysema. (Fig. 2).
DAKO technique x40 magnification.
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The tissue sample was investigated for programmed death-ligand 1 (PD-L1) and it was found to have an expression of 100% (Fig. 3.).
CT of the thorax with pneumothorax.
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Pembrolizumab was initiated, however; after 3 h the patient presented severe dyspnoia and after electrocardiographic (ECG) and imaging inspection with CT of the thorax a massive pneumothorax was observed (Fig. 4.). Due to the high PD-L1 expression we provided only immunotherapy and not in addition with chemotherapy which we saved for the case of disease progression (see Fig. 4) (see Fig. 3).
Fluoroscopy during the chest tube insertion.
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A chest tube number 30F was inserted under fluoroscopy (Fig. 5, Fig. 6.).