Surgical Management by Left Lower Lobectomy for Destroyed Lung due to Ruptured Descending Thoracic Aortic Aneurysm

Fumi Yokote, Satoshi Nagasaka, Yoshihito Arimoto, Satsuki Kina

Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan

Date, time and location: 2018.05.26 13:30, Exhibition area, 1st Floor. Zone – A

Abstract

OBJECTIVE: We report a case of successful management of destroyed lung due to ruptured descending thoracic aortic aneurysm through left lower lobectomy.

METHODS: A 79-year-old-man was admitted with sudden-onset of hemoptysis. The diagnosis was a ruptured descending thoracic aortic aneurysm with a left lung hematoma. Emergency thoracic endovascular aortic repair was performed. After surgery, he had limited hemosputum, but there was no hemoptysis. One year after surgery, he was again admitted with sudden-onset of hemoptysis which had occurred twice in a month. There were no endoleaks on computed tomography, thus a conservative treatment was selected. After two months, he referred to our hospital for recurrent hemoptysis and hemosputum.

RESULTS: We performed a bronchofiberscopy to find the source of bleeding, but no bleeding was noted. Thus, we made a diagnosis of a hemoptysis caused by the destroyed lung because of repeated pneumonia, and decided to perform a left lower lobectomy. Surgical access was achieved via a left-sided posterolateral thoracotomy. Marked adhesions were present between the descending aorta and the posterior left lower lobe because of inflammation. We separated the adhesions carefully, but a part of the stent graft was exposed. Thus, we performed patch closure using pericardial fat for the exposed stent graft to prevent stent graft infections. The patient fully recovered after lobectomy, and was discharged without any complications.

CONCLUSION: Stent graft complications after primary thoracic endovascular aortic repair are not infrequent and often required secondary procedures for definite treatment. Despite the high risk of complications, secondary open surgical procedures may be successfully performed with an acceptable outcome. It is important to consider the debridement of infected tissues and hematoma to prevent repeating hemoptysis.