Patient Undergoes Left Lung Lobectomy and Dies From Ruptured Pulmonary Artery

This case involves a 59-year-old male with a past medical history significant for lung cancer. The patient underwent a left upper lung lobectomy and mediastinoscopy. Four days after being discharged from the hospital, the patient was readmitted for an acute episode of shortness of breath. A CT scan showed fluid collecting in the post-resection space with air-fluid levels in the upper portion of the lobectomy space. The patient was subsequently transferred to SICU and then to a step-down unit. A portable x-ray of the chest showed the collection of fluid completely obliterating the left lung field. In the step-down unit, the patient continued to experience difficulty breathing. He was later transferred back to ICU at which point he was unresponsive, a code was called, and the patient was intubated. Shortly thereafter a bedside thoracotomy and chest tube placement revealed dark blood in the left pleural cavity. Approximately 5000 ml of blood was evacuated from his left chest but the patient did not survive. The surgical autopsy attributed death to focal necrosis and acute inflammation with rupture of the pulmonary artery.

Question(s) For Expert Witness

1. Could a more prudent monitoring of this patient have changed his outcome?

Expert Witness Response E-001199

It is not unusual to see fluid collections post lobectomy, and certainly it is quite common to see them post-pneumonectomy. It is unusual to find a fluid collection that obliterates the entire lung field after a lobectomy. The chronology of the case with particular emphasis on the progression and timing of the fluid collection would paint a clearer picture, but if indeed a progressive fluid collection was not evaluated in a timely manner, this could indeed represent a deviation from the accepted standard of care. Bleeding and infection are both emergent and treatable conditions that must be excluded in a timely manner.