Abstract
A 78-year-old man with advanced lower thoracic esophageal cancer underwent neoadjuvant chemotherapy with cisplatin/5FU, followed by a video-assisted thoracoscopic (VATS) esophagectomy in the prone position. At the insertion of the first port during the thoracoscopic operation, severe lung injury and arterial bleeding were observed. The injury was caused by pleural adhesion at the port insertion area. The bleeding was stopped by lung suturing, and the planned operation was completed. The patient was discharged on the 15th post-operative day without complications. A follow-up chest X-ray 31 days post-surgery revealed a mass lesion of the right lung, and based on a contrast enhanced computed tomography the mass was diagnosed as a 4-cm-dia. pseudo-aneurysm of the peripheral pulmonary artery. Selective pulmonary arteriography via the right femoral vein revealed an A8 pseudo-aneurysm, and transcatheter coil embolization was performed. The patient's recovery after angiography was uneventful, and he was discharged 4 days after the embolization. He has been followed up in the clinic as of 1 year and 7 months since the operation, with a favorable general condition and no cancer recurrence. The adhesion between the patient's lung and chest wall probably caused the lung injury during the VATS-esophagectomy. Although a pseudo-aneurysm of the pulmonary artery is a very rare complication after lung injury, immediate treatment to prevent bleeding into the airway is required. Transcatheter coil embolization is safe and less invasive, even after an esophagectomy.
