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[Bulla Appearing and Rupturing after Right Upper Lobectomy, Causing a Significant Pulmonary Fistula:Report of a
Kenji Kimura1, Ichinosuke Kuza
1Department of Thoracic Surgery, Saiseikai Hyogo Prefectural Hospital, Kobe, Japan.
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|November 18, 2025
Summary
Persistent air leaks after lung cancer surgery complicated this patient's recovery. Reoperation revealed a previously undetected bulla, and subsequent pleurodesis was required to resolve the air leak and ensure recovery.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Surgical Oncology
Background:
- Lung adenocarcinoma is a common malignancy requiring surgical intervention.
- Postoperative air leaks are a known complication following lung resections.
- Persistent air leaks can lead to prolonged hospitalization and increased morbidity.
Purpose of the Study:
- To report a case of persistent air leaks following thoracoscopic right upper lobectomy.
- To describe the diagnostic and management challenges encountered.
- To highlight the importance of identifying all potential air leak sources.
Main Methods:
- A 78-year-old male patient underwent thoracoscopic right upper lobectomy for lung adenocarcinoma.
- Initial postoperative air leaks were managed conservatively, then with reoperation.
- Further management involved identifying and addressing a S6 bulla and subsequent pleurodesis.
Main Results:
- The patient experienced significant air leaks and subcutaneous emphysema post-extubation.
- Reoperation identified a previously unseen bulla in S6 as the source of the air leak.
- Two sessions of pleurodesis were ultimately required to resolve the air leak.
- The patient was discharged on the 22nd postoperative day.
Conclusions:
- Persistent air leaks after lung lobectomy can arise from unexpected sources like bullae.
- Multifaceted management, including reoperation and pleurodesis, may be necessary.
- Careful intraoperative assessment and postoperative monitoring are crucial for managing air leaks.
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