Subcutaneous and mediastinal emphysema after lobectomy: Two case reports with different courses

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Medical Complications

Background:

• Subcutaneous and mediastinal emphysema following lobectomy is uncommon.
• Typically results from minor air leaks from the residual lung.
• Contralateral pneumothorax is a rare and potentially fatal complication.

Observation:

• Two cases of post-lobectomy emphysema are presented in elderly male patients.
• One patient managed conservatively, the other developed contralateral pneumothorax requiring chest tube drainage.
• Contralateral pneumothorax occurred after readmission, suggesting a delayed onset.

Findings:

• Contralateral pneumothorax after lobectomy is an unusual complication.
• The contralateral onset may indicate a lower pressure threshold for pleural/alveolar rupture.
• Conservative management is suitable for emphysema without pneumothorax.

Implications:

• Pulmonologists must monitor the contralateral side for pneumothorax post-lobectomy.
• Follow-up radiographic examinations are recommended a few hours later.
• Awareness of this rare complication is vital for timely intervention and patient survival.