Yamada Eiji, Ohno Natsumi, Yoshioka Takashi, Muro Masahiko
Division of Thoracic Surgery, Fukuyama City Hospital, Fukuyama, Japan.
Kyobu Geka. 2018 Dec;71(13):1129-1131.
A 69-year-old man who arrived at our hospital by ambulance with dyspnea was diagnosed with pneumothorax. The chest was drained, but the left lung failed to expand due to air leakage. A pulmonary fistula in the left lower lobe identified by video-assisted thoracic surgery was repaired. Postoperative chest radiography showed inadequate expansion of the left upper lobe. Bronchoscopy revealed an obstruction of the left upper bronchus that was pathologically diagnosed as squamous cell carcinoma. Enhanced computed tomography revealed a central tumor with atelectasis of the left upper lobe, and a stained node in the left lower lobe. Clinical T4N1M0 stage III A lung cancer was confirmed. The patient was treated with concurrent chemoradiotherapy. It was likely that the lung cancer in the upper bronchus caused the atelectasis, leading secondary expansion of the lower lobe and the rupture of a bulla.
一名69岁男性因呼吸困难由救护车送至我院,被诊断为气胸。进行了胸腔引流,但由于漏气左肺未能复张。通过电视辅助胸腔镜手术发现左下叶存在肺瘘并进行了修复。术后胸部X线显示左上叶扩张不全。支气管镜检查发现左上支气管阻塞,病理诊断为鳞状细胞癌。增强计算机断层扫描显示中央型肿瘤伴左上叶肺不张,左下叶有一个强化结节。确诊为临床T4N1M0 III A期肺癌。该患者接受了同步放化疗。很可能是上支气管的肺癌导致了肺不张,继而引起下叶继发性扩张和肺大疱破裂。