Unilateral Pulmonary Fibrosis Following Lobectomy

M. Warren, University of Nevada, Las Vegas
N. Varada, University of Nevada, Las Vegas
K. D. Modi, University of Nevada, Las Vegas


Introduction Pulmonary fibrosis is a process in which scarring occurs within the lungs, leading to an excess of connective tissue, resulting in decreased areas for gas exchange and ventilation. This process can be secondary to systemic diseases, drug toxicity, or other unknown causes. Our case presents an unusual presentation of unilateral pulmonary fibrosis as a sequela of lobectomy. Case SummaryThe patient is a 66 year old male, with a past medical history of COPD and valley fever, who initially presented for complaints of SOB. He had been diagnosed with Valley Fever over 4 prior and had been taking fluconazole chronically. He had been noted to have a cavitary lung lesion in his left upper lobe, during his initial work up for valley fever. Due to the onset of hemoptysis, he was sent for a consultation with CT Surgery, who recommended the patient undergo an elective left lung lobectomy. The patient eventually received the lobectomy but had persistent SOB for which he was admitted. During that admission a CT angiogram of the chest was ordered, which demonstrated pleural thickening and fibrotic changes in the left lung, which was noted by the radiologist to demonstrated peripheral pleural thickening and scarring seen in the left lung, predominantly at the left lung apex. The Fibrotic changes were noticed post surgery, and it was initially thought it was due to post operative changes in the lungs, as V/Q scan demonstrated 80% of blood flow went to the left upper lobe. Review of imagining and with the recent surgical procedure, it was determined this was the patients new baseline, and was discharged on oxygen. ConclusionPulmonary fibrosis is usually a bilateral condition, and though often times a cause cannot be found, it does develop as a result of exposure to certain factors. Unilateral pulmonary fibrosis is a rare lung condition, and is often associated with the interruption of the lung vasculature, single lung ventilation or radiation pneumonitis. Our patient demonstrates a unique case of a lobectomy of the left upper lobe, interrupting vasculature and thus causing fibrosis in the remaining portion of the left lung. This procedure was indicated and initially welcomed by the patient due to his chronic valley fever, however caution should be advised when undergoing the procedure due to the risk of developing further fibrosis to the lung.