Coughing-induced Pulmonary Barotrauma after Pulmonary Lobectomy

A left upper lobectomy was performed in an 80-year-old man with lung cancer. There was no air leakage after surgery, but on the evening of the next day severe subcutaneous emphysema and a massive air leakage developed after he had suffered bouts of coughing. In response to his worsening symptoms, he underwent surgery, which identified a subpleural pocket-like tear on the remaining lower lobe. There had been no evidence of emphysematous changes in his preoperative findings. This case demonstrates the need to consider reinforcing the pulmonary surface facing a large dead space to avoid coughing-induced pulmonary barotrauma.