Visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy
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CASE REPORT
Open Access
Visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy Yasushi Mizukami*, Nobuhito Ueda, Hirofumi Adachi and Jun Arikura
Abstract Background: Pulmonary visceral subpleural hematoma is rare. We report visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy. This very rare case was difficult to distinguish from thoracic abscess. Case presentation: A 68-year-old man with hypertension had undergone video-assisted thoracoscopic left upper division segmentectomy for suspected lung carcinoma. Deep vein thrombosis of the lower leg was identified and edoxaban, a so-called novel oral anticoagulant, was started on postoperative day 7. The chest drainage tube was removed on postoperative day 12 because of persistent air leakage, but fever appeared the same day. Computed tomography revealed a cavity with mixed air and fluid, so antibiotics were started on suspicion of abscess. Computed tomography-guided drainage was attempted, but proved unsuccessful. Fever continued and surgical investigation was therefore performed. Visceral subpleural hematoma was identified under the diaphragmatic surface of the left basal lung. We excised the pleura, then performed drainage and applied running sutures. The parenchyma and visceral pleura were covered with polyglycolic acid sheet and fibrin glue. Edoxaban was restarted on postoperative day 12 of video-assisted thoracoscopic surgery and no recurrence of hematoma has been revealed. Conclusions: Visceral subpleural hematoma after thoracic surgery is extremely rare. Furthermore, correct diagnosis was difficult and surgery offered a good diagnostic and therapeutic procedure. Keywords: Visceral subpleural hematoma, Lung resection, Vats, Segmentectomy
Background Pulmonary visceral subpleural hematoma is rare, and has also been reported as pulmonary pseudocyst [1–4]. These lesions are caused by trauma, but postoperative visceral subpleural hematoma is extremely rare. We report a case of visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy. Distinguishing pulmonary visceral subpleural hematoma from thoracic abscess is difficult. We performed video-assisted thoracoscopic surgery (VATS) to diagnose and treat our case.
* Correspondence: [email protected] Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, 2-3-54 Kikusui 4-jo, Shiroishi-ku, Sapporo-shi, Hokkaido 003-0804, Japan
Case presentation The patient was a 68-year-old man with hypertension. He was not receiving anticoagulants and had no history of smoking. Chest X-ray in a regular check-up revealed an abnormal chest shadow and he was referred to our department. A 30-mm ground glass nodule in the left upper lobe (S1 + 2) was identified on chest computed tomography (CT) and lung adenocarcinoma was suspected (Fig. 1). Fluorodeoxyglucose (FDG)-positron emission tomography (PET), brain magnetic resonance imaging and transbronchial bi
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