Aortogenic embolic stroke after sleeve pneumonectomy with median sternotomy for lung cancer: a case report

Hirotoshi Suzuki, Masafumi Noda, Tatsuaki Watanabe, Yasushi Matsuda, Yasushi Hoshikawa, Yoshinori Okada

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The median sternotomy approach in sleeve pneumonectomy enables diseased lung ventilation in selected cases, which may reduce the difficulty in achieving anastomosis under intubation of the left main bronchus. However, with median sternotomy, the ascending aorta requires repeated mobilization to expose the operative field for anastomosis, which can cause an aortogenic embolic stroke. CASE PRESENTATION: A 70-year-old Asian man presenting 6 months after developing hemoptysis was diagnosed with right upper lobe lung cancer (stage T4N0M0), invading the lower trachea and basal bronchus. Preoperative computed tomography revealed ascending aorta calcification. Right sleeve pneumonectomy was performed using median sternotomy with diseased lung ventilation. The ascending aorta was repeatedly mobilized to adequately expose the tracheobronchial bifurcation. Surgery was uneventful, but he did not recover complete consciousness even after termination of anesthesia. Mild paralysis of both upper extremities was observed. Head magnetic resonance imaging on postoperative day 1 revealed multiple small acute infarctions in the brain, possibly caused by mobilization of the aorta. He received anticoagulation therapy and rehabilitation and was discharged on postoperative day 30. CONCLUSION: The median sternotomy approach in sleeve pneumonectomy enables diseased lung ventilation. However, the possibility of aortogenic embolic stroke should be considered when calcification of the ascending aorta is observed on preoperative computed tomography.

Original languageEnglish
Pages (from-to)205
Number of pages1
JournalJournal of Medical Case Reports
Volume15
Issue number1
DOIs
Publication statusPublished - 2021 Apr 28

Keywords

  • Aortogenic embolic stroke
  • Diseased lung ventilation
  • Sleeve pneumonectomy with median sternotomy

ASJC Scopus subject areas

  • Medicine(all)

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