What happened, in summary

This 66-year-old man was referred after routine chest radiography showed a 3 cm abnormality in the left middle lung field. He had previously smoked 20 cigarettes per day but had quit 16 years earlier. His medical history included cerebral infarction treated with clopidogrel and hypertension treated with candesartan. Blood tests were not concerning, and tumor markers were normal, including CEA 2.1 ng/mL, SCC antigen 1.5 ng/mL, and cytokeratin 19 fragment 0.9 ng/mL. Contrast-enhanced CT showed a 4.6 cm ground-glass nodule with a 4 cm solid component in the S9/10 region of the left lower lobe, with no emphysema and normal respiratory capacity on pulmonary function testing. PET-CT showed only mild uptake in the lung mass and no distant metastasis, and brain MRI showed no brain metastasis. Bronchoscopy did not prove cancer, but the lesion was suspected to be clinical Stage IB primary lung cancer. During four-port thoracoscopic surgery, needle biopsy confirmed adenocarcinoma, so surgeons completed a left lower lobectomy with lymph node dissection. The operation was complicated by an air leak at the interlobar fissure and a separate perforated pneumatocele on the mediastinal side of the upper lobe. The team repaired the leak with suturing, pleural excision, soft coagulation, TachoSil, and fibrin glue. A small postoperative air leak required 50% dextrose adhesive therapy, and the drain was removed on postoperative day 5 after continued close monitoring. As of March 2025, CT follow-up showed no cystic lesions and no recurrence of lung cancer.