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A pulmonary shadow after lobectomy: an unexpected diagnosis.

A 62-year-old man underwent a right upper lobectomy because of a recently diagnosed non-small cell lung carcinoma pT2aN0M0, stage IB. His medical history showed chronic obstructive pulmonary disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification 2 and a myocardial infarction in 2009. During the operation there were no complications. A few hours after the operation the patient could be extubated. Postoperatively, the patient had no complaints, nor were there any abnormalities on physical examination. His routine laboratory results showed slight anaemia (haemoglobin 7.0 mmol/l), a slightly decreased haematocrit level (0.32 l/l) and an increased level of C-reactive protein (88 mg/l). The chest X-ray one day after surgery showed a dense opacity in the upper zone of the right lung (figure 1). On the first day the pleural drain produced 1 litre of serosanguinolent fluid per 24 hours, gradually diminishing to 500 ml per 24 hours, with moderate air leak.