No abstract
Lobectomy is a commonly performed procedure for lung masses that can have serious complications. Common postoperative complications include pulmonary hemorrhage, persistent air leak, empyema, pneumonia, bronchopneumonia fistula, atelectasis, and ARDS. We present a case of a female with recent lobectomy who presented with multiple vague complaints and was found to have severe necrotizing pneumonia. A 64-year-old female with COPD (on home oxygen 2L as needed), GERD, depression, recent left upper lobe lobectomy for nonmalignant lung mass, and current tobacco use presented to the ED with chills, non-productive cough, fatigue, frontal headache, and non-focal weakness. The patient was traveling from a small rural town to accompany a family friend that was undergoing surgery the following day. The patient, family friend, and patient's daughter stayed overnight at a hotel and the following day the patient woke up with chills, weakness, and a non-productive cough. Symptoms progressed and she was brought to the University of Arkansas for Medical Sciences (UAMS) ED for evaluation. In the ED, the patient was febrile, tachycardic, normotensive, tachypneic, and hypoxic on room air. Labs significant for WBC: 17.04, Glucose: 237, and lactate: 2.5. The patient was placed on 2L O2 via NC and sepsis protocol was initiated. Chest x-ray showed completed white out of the left lung and the patient was admitted to general medicine for presumed community-associated pneumonia. The patient was continued on broad-spectrum antibiotics and blood and sputum cultures returned positive for streptococcus pneumoniae and pan-sensitive pseudomonas, respectively. Pulmonary consulted for evaluation for LLL hydropneumothorax vs lung abscess. Bedside ultrasound of the left lung showed hepatization without fluid and CT chest showed an abrupt termination of the left main bronchus with severe necrotizing LLL pneumonia and ground glasses changes in the right upper lobe with reactive lymphadenopathy. The patient underwent bronchoscopy which showed complete occlusion of the left mainstem bronchus. Cardiothoracic surgery (CTS) consulted and recommended a V/Q scan, which showed 2.9% of total perfusion and 5.1% of total ventilation was provided by the left lung. The patient underwent completion of left pneumonectomy by CTS without complications and was discharged on a seven-day course of Bactrim. Postoperative complications after a lobectomy carry a significantly increased risk of morbidity and readmission to the hospital. If necrotizing pneumonia is suspected, it is unknown whether surgical resection is superior to medical management, but surgical resection should be sought earlier if the patient's clinical condition does not improve with antibiotics.
No abstract
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