Bronchoscopic Drainage of a Persistent Lung Abscess Using CBCT-Guided Aspiration Under Superimposed High-Frequency Jet Ventilation.

Abstract

Lung abscesses represent complex localised infections of the lung parenchyma. If they fail to resolve with conventional medical and surgical therapy, they pose a significant clinical challenge, particularly when the lesion is poorly accessible to percutaneous or open drainage. The evolution of advanced bronchoscopic techniques including cone-beam computed tomography (CBCT) and superimposed high-frequency jet ventilation (SHFJV) now allows for precise, minimally invasive interventions in such complex cases. We report a case of a persistent right upper lobe abscess due to invasive pulmonary infection that was successfully drained bronchoscopically. CBCT imaging enabled real-time, three-dimensional localisation and confirmation of needle placement within the abscess cavity. SHFJV, delivered through a jet converter system and endotracheal tube, stabilised the lung and minimised motion artefact during imaging and intervention. This case highlights the potential for bronchoscopic intervention in the multidisciplinary management of complex pulmonary infections. This procedure, performed entirely through flexible bronchoscopy, demonstrates how newer technical innovations enhance procedural accuracy, improve safety, and expand the therapeutic potential of interventional pulmonology beyond the traditional confines of rigid bronchoscopy.