A Case of Bronchial Diverticulum With Progressive Enlargement and Abscess Formation Successfully Managed by Endobronchial Ultrasound‐Guided Transbronchial Needle Aspiration and Antibiotic Therapy

TL;DR

An 80-year-old man with a long-standing bronchial diverticulum developed an infection, which was successfully treated with a minimally invasive procedure and antibiotics.

Contribution

Demonstrates successful non-surgical management of an infected bronchial diverticulum using EBUS-TBNA.

Findings

EBUS-TBNA safely aspirated and identified alpha-hemolytic Streptococcus in a bronchial diverticulum abscess.

Antibiotic therapy alone resolved the infection without surgical intervention.

Long-term asymptomatic bronchial diverticula can develop late complications like infection.

Abstract

Bronchial diverticulum (BD) is a rare airway abnormality that rarely enlarges significantly or becomes infected. We report a case of an 80‐year‐old male with a 15‐year history of asymptomatic BD that gradually increased in size and eventually developed into an abscess. Chest computed tomography revealed a cystic lesion adjacent to the left main bronchus with internal fluid and surrounding inflammation. Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) enabled safe aspiration and identification of alpha‐hemolytic Streptococcus despite the absence of a visible bronchial opening. The infection was successfully managed with antibiotics alone, thereby avoiding surgical intervention. This case highlights the potential for long‐term asymptomatic BD to develop infection and demonstrates the diagnostic utility of EBUS‐TBNA for lesions adjacent to vital structures. However, further studies are needed to clarify infection risk factors and optimal management strategies for BD.

This report describes an 80‐year‐old male with bronchial diverticulum that remained asymptomatic for over 15 years before gradually enlarging and developing into an infected abscess. Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) successfully identified alpha‐hemolytic Streptococcus and enabled targeted antibiotic treatment without surgical intervention. This case indicates that late complications may develop in long‐standing bronchial diverticulum and demonstrates the benefits of EBUS‐TBNA for managing complicated lesions adjacent to vital structures.

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