Recurrent Lung Adenocarcinoma Complicated by a Tracheopericardial Fistula

What happened, in summary

A 72-year-old man had undergone right upper lobectomy for Stage II lung adenocarcinoma in November 2016, followed by 6 cycles of chemotherapy. Tumor testing did not identify a gene mutation that could guide targeted treatment.

In October 2018, an enlarging mediastinal lymph node raised concern for recurrence. He received 3 cycles of cisplatin and pemetrexed, then declined further chemotherapy and continued follow-up. By early 2024, recurrent tumor was involving the trachea and causing severe airway narrowing. He underwent two bronchoscopic tumor-debulking procedures and radiation. When the disease progressed further, he received 3 cycles of pemetrexed, carboplatin and bevacizumab and responded favorably.

In June 2024, he was admitted with fever and chest pain. An initial heart-attack evaluation was negative. Imaging instead showed air around the heart, and bronchoscopy identified a fistula connecting the trachea with the pericardial space. Drainage and antibiotics were started while closure of the fistula was planned.

On the fifth hospital day, he developed massive hemoptysis followed by cardiac and respiratory arrest and could not be resuscitated. He died about 7½ years after his November 2016 lung-cancer diagnosis.