A case of hemoptysis after lung cancer resection due to pneumatocele which rapidly developed

A 72-year-old man who was diagnosed with squamous cell carcinoma in the right lung underwent right upper lobectomy via video-assisted thoracoscopic surgery. The fused fissures were divided with staplers after the pulmonary veins, arteries, and bronchus were divided due to severe pulmonary emphysema and largely fused fissures. Two hours after the lobectomy, mechanical ventilation was started again because massive hemoptysis appeared. A diagnosis of pneumatocele at S7 which developed postoperatively was made based on the findings of chest computed tomography and thoracoscopy. Right S7+8 segmentectomy was performed 8 days after the lobectomy because hemosputum persisted. After segmentectomy, a two-staged thoracoscoplasty was performed for pneumonia and pyothorax, and he could leave the hospital 9 months after the lobectomy. We speculated that the cause of pneumatocele formation was excessive tensile force around the thick staple line because the emphysematous lung with largely fused fissures was divided with staplers. Additional staple line reinforcement by oversewing or ligation might be needed in cases of a brittle staple line. Furthermore, early surgical intervention should be considered in cases of persisting massive airway bleeding from the pneumatocele.