Arteriobronchial fistula complicating right upper lobectomy

Bronchial stump fistula (BSF) is a known complication after lobectomy, although its incidence after lobe resection for non-small cell lung cancer usually does not exceed 2%. We present the case of a patient in whom a late BSF developed that led to a fatal pulmonary hemorrhage 4 weeks after right upper lobectomy and 4 hours after emergency readmission. Such a pulmonary hemorrhage could have been prevented by pulmonary artery embolization and intrapericardial pneumonectomy. The decision to perform pneumonectomy as a preventative procedure without overt clinical symptoms was a difficult decision to reach, particularly given the likelihood of being unnecessarily aggressive.