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Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer

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[Massive hemoptysis after lobectomy for bronchiectasis].

Hirokazu Tanaka¹, Y Nishizaka, M Yamazaki

¹Department of Chest Surgery, Osaka Red Cross Hospital, Osaka, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery

|September 22, 2009

Summary

This summary is machine-generated.

Post-surgery bleeding (hemoptysis) recurred due to a significantly developed bronchial artery in the adjacent lobe. Embolization of this artery stopped the bleeding, highlighting the risk of altered blood flow after lung surgery.

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Area of Science:

Cardiovascular Medicine
Thoracic Surgery
Pulmonary Medicine

Background:

Bronchiectasis is a chronic lung condition often associated with recurrent hemoptysis.
Surgical intervention, such as lobectomy, is considered for severe or intractable cases.
Preoperative assessment of bronchial artery anatomy is crucial for surgical planning.

Observation:

A 67-year-old female with a 50-year history of hemoptysis underwent left lower lobectomy for bronchiectasis.
Postoperatively, massive hemoptysis occurred, leading to respiratory compromise.
Bronchial arteriography revealed a markedly developed left upper lobe bronchial artery with the bleeding site localized there.

Findings:

The bleeding was successfully controlled by embolizing the hypertrophied left upper lobe bronchial artery.
The previously normal-appearing left upper lobe was the source of the massive postoperative hemorrhage.
This suggests a compensatory hypertrophy of the bronchial artery supplying the contralateral lobe.

Implications:

Altered bronchial artery hemodynamics following lung surgery can precipitate severe postoperative hemoptysis.
Careful evaluation of bronchial artery patterns, including potential contralateral supply, is essential.
This case underscores the importance of considering collateral circulation in managing hemoptysis after pulmonary resections.