Detection of Pericardial Defect During Lung Cancer Surgery with Proposal for Reconstruction

Abstract

We report a rare case of pericardial defect detected during lung cancer resection. A 60-year-old male patient presented with a mixed ground-glass nodule about 17 mm in diameter at the left S6b area. During a left lower lobectomy, naked atrium was observed. The operation was completed without any reconstruction, and the patient survived without recurrence or complications two year after surgery. Pathologically, the tumor was lepidic adenocarcinoma of surgical stage IA2 with pT1bN0M0. To date, 13 lung cancers with pericardial deficiency have been reported in Japan. Reconstruction should be considered in the following cases: in pneumonectomy cases after detaching adhesion between the lung and heart, cases in which poor expansion of the remaining lobes after lobectomy is insufficient to sustain the heart, or cases with a defect around the apex. Because pericardial defect is not detected preoperatively, thoracic surgeons should be aware of this congenital disease and indications for the reconstruction.