In-hospital Stroke Developed after Left Upper Lobectomy for Left Lung Adenocarcinoma—A Case Report—

Abstract

A 51-year-old man with a smoking history presented with right pneumothorax. A chest computed tomography incidentally showed a nodule shadow 2.5 cm in diameter in the left pulmonary upper lobe. The patient underwent thoracoscopic left upper lobectomy with the diagnosis of lung adenocarcinoma. Postoperative course had been good until cerebral stroke occurred on the 9^th postoperative day. A brain magnetic resonance angiography showed the occlusion of the right middle cerebral artery. The patient was transferred to an Acute Ischemic Stroke Center within 2 hours after the onset of the stroke, because we have no facilities for neuroendovascular treatment. He could receive successful recanalization through endovascular thrombectomy at the Center. Ten months later, the patient became ambulatory, and was discharged home. He has no recurrence. Recently, several reports suggest that thrombosis in the stump of the pulmonary vein after lobectomy, especially after left upper lobectomy, causes embolic cerebral infarction on rare occasions. Endovascular thrombectomy is a useful technique for treating acute embolic cerebral infarction after surgical intervention. If it is difficult to provide endovascular thrombectomy for patients with cerebral stroke at our own hospital, it is important to enhance medical collaboration between hospitals on a usual basis for rapid treatment against embolic cerebral infarction.