Hypertensive Late Hemothorax following Left Pneumonectomy
O. Rus, C. Motas, N. Motas, D. Achim, T. HorvatClinical case, no. 6, 2014
Introduction: Lung cancer is an extremely serious disease, inmost cases the onset of symptoms comes in late stages of thedisease. Local and distant tumor development limits thesurgical indication, many times the surgical act being a heroicone. Out of all pulmonary resections pneumonectomies arereal challenges as possible postoperatory complications canbe life-threatening.Materials and Method: We present the case of a 66 year-oldfemale patient at the time of surgery, diagnosed with locallyadvanced adenocarcinoma of the left lung (lower lobe tumorinvading the upper lobe), who sustained left pneumonectomywith mediastinal lymphadenectomy in March 2012. Immediatepostoperative evolution was favorable â€" gradual reduction of theresidual cavity, with left shift of the mediastinum â€" basically anormal post-pneumonectomy course.Results: Upon imagistic control at one year postoperatively the following was observed: the residual cavity had increased insize under the pressure of a fluid which instead of diminishingin quantity was present in a significantly higher volume thanon previous postoperative examinations. The general consensuswas that we are dealing with pleural metastases which wereproducing excess pleural fluid. The evolution of the patient andsubsequent surgical interventions have demonstrated that thefirst impression is not always the truth.Conclusion: There are cases, like the one presented, which seemwithout therapeutic solution. Upon careful analysis, dubled byperseverance, these cases benefit from spectacular results whichbreak down grim hypotheses previously formed. Associatedpathology can create in these cases an unbalance in theorganism, which will negatively influence local postoperativeevolution.
