Early lung adenocarcinoma found on screening with surgical recovery after tamponade complication

What happened, in summary

This 64-year-old Han Chinese man, a never-smoker, was evaluated after a right upper-lung nodule was found during routine health screening. Initial CT showed a 2.3 x 1.9 cm nodule, and surveillance imaging showed that it had enlarged to a 2.5 cm mixed ground-glass opacity in the anterior segment of the right upper lobe. PET-CT showed only mild metabolic activity and no nodal or distant metastasis, so the working cancer stage remained early and potentially curable with local treatment. Because he also had hypertension and significant coronary artery disease, the surgical plan emphasized reducing operative risk while still removing the suspicious lung lesion completely.

After multidisciplinary discussion, he underwent VATS right upper-lobe wedge resection with lymph-node sampling rather than a larger lung resection. Intraoperative frozen pathology confirmed lung adenocarcinoma with clear margins. The operation lasted about 1 hour and blood loss was minimal, although the surgeon noticed unusual resistance while firing the stapler.

Three hours after surgery, he suddenly developed severe hypotension and altered consciousness. Chest tube output was not bloody, but bedside echocardiography showed massive pericardial effusion with right atrial collapse, confirming cardiac tamponade. He underwent emergency pericardiocentesis, intubation, and VA-ECMO support. Median sternotomy then revealed active bleeding from the ascending aorta. A malformed staple had eroded through the pericardium into the aortic wall, and the perforation was repaired with reinforced sutures. He remained on ECMO and mechanical ventilation after surgery. ECMO was stopped on postoperative day 2, he was extubated on day 7, and he was discharged on day 19 with full recovery after both cancer surgery and the life-threatening complication.