Cavitating Lung Infarction After Lobectomy for Squamous Cell Lung Cancer

What happened, in summary

A 75-year-old woman underwent a right video-assisted thoracoscopic upper lobectomy for T3N0M0 squamous cell lung carcinoma. She was discharged five days after surgery without an apparent complication. Soon afterward, she developed nausea, intermittent shortness of breath, and severe pain near the right shoulder blade. Imaging was initially interpreted as a lung abscess, and she was sent home with ciprofloxacin. Her condition worsened, with fever, haemoptysis, breathlessness, and markedly raised inflammatory markers, leading to readmission. The clinical team changed her antibiotic treatment to clindamycin. Her inflammatory markers gradually improved, and she was discharged after six days with a further month of treatment. Review of the case concluded that the cavity represented a postoperative pulmonary infarction that had cavitated and become infected. Variant pulmonary arterial anatomy had made the lobectomy more complex and contributed to the complication. At four-month follow-up, imaging showed a major reduction in the cavity, her symptoms had improved substantially, and she returned to routine postoperative follow-up. She still had a reduced appetite and found exercise more difficult than before, but she could walk for about an hour on most days. She expressed relief that the tumour had been removed and gratitude that recovery was progressing, while emphasizing how communication between clinical teams could improve recognition and treatment of surgical complications.