What happened, in summary

This 61-year-old nonsmoking man was admitted 1 day after a car accident with severe right chest pain. He had no prior chest disease, surgery, or chest imaging during the previous 5 years. CT showed an air-filled, cystlike lesion in the middle third of the right upper lung, surrounded by solid components and ground-glass opacity, without rib or sternal fractures. The lesion was initially considered a traumatic pulmonary pseudocyst, so he was treated conservatively. On the third day after trauma, he developed hemoptysis, which was controlled with intravenous hemostatic medication: etamsylate, aminomethylbenzoic acid, and vitamin K1. On the ninth day, he had significant hemoptysis and moderate shortness of breath. Repeat CT showed that the solid components had entered the cavity and enlarged, and the surrounding ground-glass opacity had slightly increased. Contrast-enhanced CT and 3D reconstruction showed that the solid component was a hematoma caused by injury to the right upper pulmonary vein. Because of concern for severe intrapulmonary bleeding, he underwent video-assisted thoracoscopic right upper lobectomy. Intraoperative frozen section showed bleeding and inflammatory infiltration in the lung parenchyma, not obvious cancer. The cancer diagnosis came afterward: postoperative pathology unexpectedly showed primary lung adenosquamous carcinoma. Final staging was T1aN0M0, Stage IA1. He recovered without complications and was discharged on postoperative day 7. As of September 2024, he had been followed for 2 years with no recurrence. The tumor was found only because surgery was needed for bleeding risk, not because cancer had been suspected before the operation. This made the diagnosis unusually incidental.