Abscess of residual lobe after pulmonary resection for lung cancer.
Abscess of the residual lobe after lobectomy is a rare but potentially lethal complication. Between January 1975 and December 2006, 1,460 patients underwent elective pulmonary lobectomy for non-small-cell lung cancer at our institution. Abscess of the residual lung parenchyma occurred in 5 (0.3%) cases (4 bilobectomies and 1 lobectomy). Postoperative chest radiography showed incomplete expansion and consolidation of residual lung parenchyma. Flexible bronchoscopy revealed persistent bronchial occlusion from purulent secretions and/or bronchial collapse. Computed tomography in 3 patients demonstrated lung abscess foci. Surgical treatment included completion right pneumonectomy in 3 patients and a middle lobectomy in one. Complications after repeat thoracotomy comprised contralateral pneumonia and sepsis in 1 patient. Residual lobar abscess after lobectomy should be suspected in patients presenting with fever, leukocytosis, bronchial obstruction and lung consolidation despite antibiotic therapy, physiotherapy and bronchoscopy. Computed tomography is mandatory for early diagnosis. Surgical resection of the affected lobe is recommended.
Ligabue
Tommaso
T
Thoracic Surgery Unit, University Hospital of Siena, Viale Bracci 14, 53100 Siena, Italy. tligabue@hotmail.com
Voltolini
Luca
L
Ghiribelli
Claudia
C
Luzzi
Luca
L
Rapicetta
Cristian
C
Gotti
Giuseppe
G
D000368:Aged; D000402:Airway Obstruction / Q000150:complications / Q000209:etiology; D001424:Bacterial Infections / Q000150:complications / Q000209:etiology; D001982:Bronchial Diseases / Q000150:complications / Q000209:etiology; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D017558:Elective Surgical Procedures; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D008169:Lung Abscess / Q000209:etiology* / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D001261:Pulmonary Atelectasis / Q000150:complications / Q000209:etiology; D013902:Radiography, Thoracic; D012086:Reoperation; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013492:Suppuration; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome