Visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy.
BACKGROUND
Pulmonary visceral subpleural hematoma is rare. We report visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy. This very rare case was difficult to distinguish from thoracic abscess.


CASE PRESENTATION
A 68-year-old man with hypertension had undergone video-assisted thoracoscopic left upper division segmentectomy for suspected lung carcinoma. Deep vein thrombosis of the lower leg was identified and edoxaban, a so-called novel oral anticoagulant, was started on postoperative day 7. The chest drainage tube was removed on postoperative day 12 because of persistent air leakage, but fever appeared the same day. Computed tomography revealed a cavity with mixed air and fluid, so antibiotics were started on suspicion of abscess. Computed tomography-guided drainage was attempted, but proved unsuccessful. Fever continued and surgical investigation was therefore performed. Visceral subpleural hematoma was identified under the diaphragmatic surface of the left basal lung. We excised the pleura, then performed drainage and applied running sutures. The parenchyma and visceral pleura were covered with polyglycolic acid sheet and fibrin glue. Edoxaban was restarted on postoperative day 12 of video-assisted thoracoscopic surgery and no recurrence of hematoma has been revealed.


CONCLUSIONS
Visceral subpleural hematoma after thoracic surgery is extremely rare. Furthermore, correct diagnosis was difficult and surgery offered a good diagnostic and therapeutic procedure.
['Mizukami|Yasushi|Y|', 'Ueda|Nobuhito|N|', 'Adachi|Hirofumi|H|', 'Arikura|Jun|J|']
D000230:Adenocarcinoma D000077192:Adenocarcinoma of Lung D000368:Aged D003964:Diaphragm D006406:Hematoma D006801:Humans D008175:Lung Neoplasms D008297:Male D010995:Pleural Diseases D011013:Pneumonectomy D019106:Postoperative Hemorrhage D020775:Thoracic Surgery, Video-Assisted D014057:Tomography, X-Ray Computed
Visceral subpleural hematoma Segmentectomy Lung resection Vats