An unfortunate surgical twist

A 48-year-old man was admitted to the intensive care unit (ICU) for massive haemoptysis and acute respiratory failure 24 hours after left lower lobectomy for lung adenocarcinoma. Chest X-ray performed in the postoperative room immediately after surgery showed a normal expansion of the remaining left upper lobe (figure 1, panel A), while chest X-ray performed at ICU admission revealed a sudden opacification of the previously expanded left upper lobe with abnormal presence of air in the left costophrenic angle (figure 1, panel B, white arrow heads). After tracheal intubation, chest CT scan revealed ground glass opacities with alveolar consolidation and volume loss of the remaining left upper lobe (figure 2, panel A) together with interlobular …