Extrapleural hematoma as a complication following thoracotomy for pulmonary lobectomy

Abstract

Extrapleural hematoma as a complication following thoracic surgery is rare. We report a case of an extrapleural hematoma following pleural lobectomy that resolved completely with nonsurgical treatment. A 63-year-old woman underwent left lower lobectomy for lung cancer through a left posterolateral thoracotomy. She had been prescribed the anticoagulant cilostazol to increase her heart rate for atrioventricular dissociation. Preoperatively, it was stopped, and a temporary pacemaker was placed to counteract bradycardia via the right jugular vein without complication. The chest tube was removed, and cilostazol was resumed on the third postoperative day. On day 7, she suddenly experienced left shoulder pain followed by hypotension, tachycardia, and anemia. Enhanced computed tomography (CT) revealed an extrapleural hematoma rather than a hemothorax. She became symptomatic after rapid infusion. The hematoma resolved without an invasive intervention. The CT results 189 days after the onset showed almost complete regression of the hematoma.

Life‐threatening extrapleural hematoma in an anticoagulated patient 2 weeks after lobectomy

“… 5 On the other hand, several cases of EP without episode of trauma were reported. Noguchi et al 1 reported EP as a complication 7 days after posterolateral thoracotomy for left lower lobectomy in an anticoagulated patient followed by a successful conservative therapy. Oka et al 6 reported that two patients with antiplatelet agents complained of pain in their shoulders or backs because of EP that originated from intercostal vessels.…”

“…This condition may occur as a complication after blunt chest trauma associated with rib or sternal fractures, which cause injury to the intercostal or parasternal vessels and also be reported as a complication after thoracotomy to be treated conservatively. 1 Here, we present a case of an anticoagulated patient with the sudden appearance of an EP 15 days after thoracoscopic lobectomy, requiring a surgical treatment because of a hemorrhagic shock.…”

Extrapleural hematoma cases treated with video-assisted thoracic surgery

“…Patients with a small EPH and stable patients do not require any interference, and hematoma may resolve spontaneously. [8] However, massive EPH, which causes severe respiratory and circulatory symptoms, requires invasive procedures. In two of our cases, the size of EPH was quite large and was causing shortness of breath.…”