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Ann Thorac Surg 1997;64:970-973
© 1997 The Society of Thoracic Surgeons

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Original Article: General Thoracic

Gangrene of the Lung: Treatment in Two Stages

Department of Thoracic Surgery, Tel Aviv University Sackler School of Medicine, Tel Aviv, and E. Wolfson Medical Center, Holon, Israel

Accepted for publication April 7, 1997.

Background. Pulmonary gangrene is a rare complication of severe lung infection with devitalization of lung parenchyma and secondary infection. If untreated, gangrene of the lung leads to sepsis, multiple-organ failure, and death. Resection of all gangrenous tissue is mandatory and is lifesaving. Pleural empyema commonly accompanies gangrene of the lung; in its presence, dissection of hilar structures for resection can lead to mediastinitis or bronchopleural fistula and should be avoided.

Methods. Three patients with pulmonary gangrene were treated in two stages: immediate fenestration first and then delayed resection of gangrenous lung in a clean field and immediate closure of the pleural window.

Results. Two patients underwent pneumonectomy and 1 patient, lobectomy. All patients recovered without complications.

Conclusions. Creation of a pleural window (fenestration) for 1 week enables safe and curative resection of a gangrenous lung or lobe in a clean field and in a patient in stable condition.

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