Pulmonary artery pseudoaneurysm after a left upper sleeve lobectomy

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CASE REPORT

WORLD JOURNAL OF SURGICAL ONCOLOGY

Open Access

Pulmonary artery pseudoaneurysm after a left upper sleeve lobectomy Minwei Bao, Yiming Zhou, Gening Jiang and Chang Chen*

Abstract A 55-year-old man was re-admitted for persistent hemoptysis and high fever three weeks after an initial left upper sleeve lobectomy for a central squamous lung cancer tumor. Pulmonary artery pseudoaneurysm and pulmonary infection were confirmed by multidetector computed tomography angiography and subsequent emergency completion pneumonectomy. The development of pulmonary artery pseudoaneurysm, secondary to post-operative pulmonary infection and pulmonary vascular manipulation, is rare and prompt surgical manipulation is mandatory. Keywords: Aneurysm, Lobectomy, Reoperation, Trauma

Background Pulmonary artery pseudoaneurysm (PAP) is a rare but potentially lethal postoperative complication. In total, there have been no more than 50 such cases documented on PubMed, among which, only two cases have evolved after right lung lobectomy [1,2]. We herein report a case of a PAP following a left upper sleeve lobectomy for a central squamous lung cancer tumor. Case presentation A 55-year-old man initially presented to our department with a 6-month refractory dry cough and bloody sputum. Physical examination and past medical history were unremarkable. Chest computed tomography (CT) showed a lesion in the left upper lobe with prominent obstructive lobar pneumonitis. Bronchoscopy revealed a neoplasm on the left superior lobar bronchus and mucosal swelling that extended to the distal end of the left main bronchus. Tissue biopsy confirmed a squamous cell carcinoma and sleeve lobectomy was scheduled after excluding remote metastasis. A routine sleeve lobectomy was performed via open thoracotomy. Three rings of the distal left lower main bronchus were removed and end-to-end bronchial reconstruction was performed after confirming negative margins by frozen section. The bronchial anastomosis

* Correspondence: [email protected] Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China

was enveloped tightly with a pedicled parietal pleura. Mediastinal nodal dissection was also completed and included stations 4–9. However, when the anesthesiologist inflated the remnant lung, we noticed an obviously tortuous pulmonary artery due to a lengthy resection of the main bronchus. Therefore, we decided to shorten the artery correspondingly. Considering that a sleeve resection of the pulmonary artery was time-consuming, a latitude-direction enfolding was performed with a continuous running suture with a 5–0 Prolene. Meticulous inspection of the pulmonary artery found neither submucous hematoma nor occlusion or narrowing of the artery. The patient recovered well and was discharged on the ninth post-operative day. The final pathology confirmed squamous cell carcinoma of the left upper lung at stage p-T2N0M0 IB. Unfortunately, the patient experienced a persistently high fever over 3