Attempted completion pneumonectomy followed by thoracoplasty after fenestration for empyema due to lung abscess

Abstract

A male in his 70s underwent right middle and lower lobectomy and ND2a-2 for right squamous cell carcinoma (cT3N1M0, stage IIIA). There were no problems noted on a chest radiograph obtained immediately after surgery, but decreased permeability of the right upper lobe developed on postoperative day (POD) 1. Bronchoscopy on POD 2 showed almost complete obstruction of the superior lobar branch. Since the volume of the upper lobe was maintained, the patient was diagnosed with pulmonary vascular congestion caused by diminished venous return and obstruction of the superior lobar branch due to edema. He was discharged from hospital on POD 31 after showing improvement. However, he subsequently developed lung suppuration concomitantly with empyema caused by rupture, and underwent fenestration surgery on POD 47. On POD 100, the entire residual lung was removed, and 6 months later the incision for thoracoplasty was closed. The patient is currently alive with no recurrence at 12 months after the first surgery and 4 months after closure of the empyema cavity. Empyema after removal of the right middle and lower lobes is usually caused by a bronchial stump fistula, but the empyema in our case was caused by lung suppuration.