Postoperative pneumatocele after right upper lobectomy: a case report

Postoperative pneumatocele is a rare complication after pulmonary resection and may mimic serious conditions such as bronchial stump failure or empyema. Accurate diagnosis is important to avoid unnecessary invasive interventions.

We report a case of a postoperative pneumatocele following a right upper lobectomy in a man in his 60s. On postoperative day 25, he presented with fever, cough, and mild hemoptysis, and computed tomography revealed a large thin-walled cavitary lesion with an air-fluid level. Bronchoscopy showed an intact bronchial stump. A drainage catheter placed for suspected pleural infection was subsequently found to have entered the cystic cavity, resulting in decompression of the lesion. Thoracoscopic exploration demonstrated no empyema cavity and revealed a thin-walled cystic lesion arising from the residual lower lobe. The lesion subsequently regressed to near-complete resolution without additional pulmonary resection.

Postoperative pneumatoceles are uncommon and may be difficult to distinguish from bronchial stump failure, empyema, or other postoperative cavitary lesions based on imaging alone. Bronchoscopy and thoracoscopy can facilitate differential diagnosis. In selected patients, cyst decompression and drainage may allow resolution without additional pulmonary resection, once major postoperative complications have been excluded.

Postoperative pneumatocele should be considered in the differential diagnosis of cavitary lesions after lung resection. A stepwise diagnostic approach, including bronchoscopy and thoracoscopy, may help to distinguish this condition from bronchial stump failure and empyema and to avoid unnecessary major surgical intervention.