CTICasesPostoperative Pulmonary Vein Occlusion after Lobectomy
Imaging findings
After an upper lobectomy, serial postoperative chest radiographs show a small pneumothorax and basilar opacity that, instead of improving, progressively worsens over several days with increasing density in the remaining lower lobe. CT obtained the same day as the last radiograph shows the superior pulmonary vein resected as expected, a patent lower lobe pulmonary artery, but occlusion of the inferior pulmonary vein with adjacent staple material and surrounding ground-glass opacity and hydropneumothorax; the airways remain normally oriented, arguing against torsion.
Key takeaways
Inadvertent occlusion or stapling of the remaining pulmonary vein is an uncommon but important complication of lobectomy that can mimic ordinary postoperative atelectasis or pneumonia, and it should be suspected when a postoperative opacity progressively worsens rather than improves despite the patient being upright and ambulatory. In this case, the congested, non-viable lower lobe ultimately required completion lobectomy, illustrating why persistent or worsening postoperative consolidation warrants CT evaluation of the pulmonary venous outflow.
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