Surgical procedure of segmentectomy as a possible cause of postoperative cerebral embolism: a case report
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(2020) 15:334
CASE REPORT
Open Access
Surgical procedure of segmentectomy as a possible cause of postoperative cerebral embolism: a case report Peirui Chen1* , Qiusha Qing2, Mingqiang Diao1, Xiaokang Sun1, Junrong Yang1 and Jing Lv1
Abstract Background: Cerebral embolism after lobectomy is a life-threatening complication during the early postoperative period. However, it is unclear if cerebral embolism can develop after segmentectomy. Case presentation: We experienced a case of a 37-year-old man who demonstrated early symptom of acute ischemic stroke in early postoperative period after right upper posterior segmentectomy and performed intraarterial mechanical thrombectomy (IAMT) successfully. Conclusions: Long and irregular pulmonary vein stump (PVS) and endothelial injury caused by surgical procedure may lead to cerebral embolism after segmentectomy. We believe that doing preoperative pulmonary vascular assessment and using appropriate surgical procedure may reduce the rate of cerebral embolism. Keywords: Cerebral embolism, Segmentectomy, Lung cancer
Background Cerebral embolism is an uncommon and serious complication during the early postoperative period after lung cancer surgery [1]. Sublobar resection (segmentectomy or wedge resection) has been recommended as an important treatment for cases of small-sized non-small cell lung carcinoma (NSCLC) [2]. Although some cases of cerebral embolism associated with lobectomy have been reported so far [1, 3, 4], cerebral embolism caused by a thrombus in the vein stump after right upper posterior segmentectomy has not been reported to our knowledge. We experienced a case of a patient with cerebral embolism in the first postoperative day, and performed intra-arterial mechanical thrombectomy (IAMT) successfully.
* Correspondence: [email protected] 1 Department of Cardiothoracic Surgery, People’s Hospital of Deyangcity, Deyang, China Full list of author information is available at the end of the article
Case presentation A 37-year-old man who was 172 cm tall and weighed 62 kg, BMI 21.5 kg/m2 underwent video-assisted thoracoscopic right upper posterior segmentectomy with systematic mediastinal lymphadenectomy. His had no history or ongoing (chronic) health problems like hypertension, diabetes mellitus, cerebrovascular disease and atrial fibrillation (AF). He had a smoking history of 15 pack-years. A an 8-mm ground-glass opacity (GGO) lesion had been identifed at the posterior segment (S2) of the right upper lobe during incidental computed tomography (CT) screening 6 months prior to his presentation to us. The ground-glass nodules grew slightly during the follow-up period (Fig. 1a). Results of all preoperative laboratory tests including electrocardiogram, blood examination and urine examination were within normal limits. Platelet function tests were not performed. During the surgery, the patient was placed in the left lateral decubitus position with the arms extended to 90°. General anesthesia was induced, and intubation was achieved via a double-lumen endobronchial tube.
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