Pulmonary infarction following a right lower lobectomy for lung adenocarcinoma in a patient with a variant ramification of the pulmonary artery
Tatsushi Kozawa Haruna Yamaki Seishi Higashi Koji Takayama Satoko Hanada Reiko Taki
Division of Respiratory Medicine, Musashino Red Cross Hospital
The patient was a 45-year-old woman with a history of a right lower lobectomy for lung adenocarcinoma two years earlier. She complained of fever, and the computed tomography (CT) scans showed ground glass opacification in the right upper lobe and an infiltrative shadow in the right middle lobe; we therefore suspected pneumonia. Although her symptom improved within several days and the infiltrative shadow in the right middle lobe diminished, the ground glass opacification in the right upper lobe increased. Since bronchoscopy did not lead to a diagnosis, we performed a CT-guided percutaneous needle biopsy. Pathological findings showed coagulative necrosis and hemorrhage, thus we diagnosed pulmonary infarction. Retrospective review of preoperative CT scans showed that the A2 pulmonary artery branched from the A6 pulmonary artery, and the postoperative CT scans revealed that A2 was no longer discernible. This indicated that A2 had been resected during the right lower lobectomy. Since the pulmonary infarction occurred in the S2 segment of the right upper lobe, the resection of A2 was presumably related to the pulmonary infarction. We suggest that pulmonary infarction should be considered as a differential diagnosis when shadows appear after pulmonary surgery.
Pulmonary infarction Variant ramification of pulmonary artery Lobectomy
Received 26 Mar 2023 / Accepted 27 Jul 2023
AJRS, 12(6): 353-357, 2023