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Case Reports
. 2024 Sep 14;16(9):e69388.
doi: 10.7759/cureus.69388. eCollection 2024 Sep.

Difficult Lung Isolation in a Heavy Smoker With a History of Left Lower Lobectomy: A Case Report

Daryl Jian An Tan  1 , Cynthia Ming Li Chia  2 , Sophia Chew  1
Affiliations
Case Reports

Difficult Lung Isolation in a Heavy Smoker With a History of Left Lower Lobectomy: A Case Report

Daryl Jian An Tan et al. Cureus. .

Abstract

Anatomical changes in the bronchial tree following a left lower lung lobectomy are not well documented in the current literature. Understanding these changes is crucial for selecting the appropriate lung isolation device and achieving optimal single-lung ventilation. We present the case of a 60-year-old female with a history of left lower lobectomy who was scheduled for elective video-assisted thoracoscopic surgery. This case highlights the unique challenges and management strategies involved, aiming to raise awareness within the medical community.

Keywords: bronchial distortion; cardiothoracic anaesthesia; case report; one lung ventilation; thoracic surgery.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative chest X-ray image demonstrating mediastinal shift to the left, elevation of the left hemidiaphragm, and pleural thickening at the left costophrenic angle. An irregularly shaped opacity, measuring 2.6 cm, is visible in the right upper lung zone. This opacity was later confirmed by biopsy to be Stage 1 non-small cell lung cancer adenocarcinoma.
Figure 2
Figure 2. Bronchoscopy examination through the left-sided DLT after placement. (A) The view through the tracheal lumen shows proper placement of the DLT, with the carina visible and the bronchial lumen cuff inflated (red arrow) positioned in the left mainstem bronchus. (B) The view through the bronchial lumen reveals excessive secretions from the left lung. (C) The image displays the short and narrow left mainstem bronchus, with the tip of the bronchial lumen obstructing the opening of the LULB (white arrow).
DLT, double-lumen tube; LULB, left upper lobe bronchus
See this image and copyright information in PMC

References

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