SUCCESSFUL SURGERY FOR A RARE AND COMPLEX PULMONARY ARTERY ANEURYSM CASE

On February 20, 2025, doctors at Nam Sai Gon International General Hospital successfully performed a highly complex and challenging thoracic surgery, marking a significant milestone for the hospital’s Department of Thoracic Surgery.

Ms. K.L. (74 years old, Cambodian) was transferred to Nam Sai Gon International General Hospital after receiving unsuccessful treatment at a local hospital, where she had initially been diagnosed with lung cancer due to a malignant mass invading the bronchus and lung.

Facing a life-threatening and misdiagnosed condition

Upon admission to the Emergency Department of Nam Sai Gon International General Hospital, the patient presented with dull pain in the left chest, a prickling sensation, dry throat, dyspnea while sitting (but relieved when lying down), no fever, and no vomiting. After a thorough clinical evaluation and imaging studies (CT scan, chest X-ray, ultrasound), the emergency team invited Assoc. Prof. Dr. Vu Huu Vinh, PhD – Head of the Thoracic Surgery Department and one of Vietnam’s leading experts in thoracic surgery – for an in-depth consultation.

Based on his clinical experience and detailed assessment of the diagnostic results, Dr. Vinh identified a giant pulmonary artery aneurysm on the left side, measuring up to 15 cm, stretching from the origin of the left pulmonary artery through both upper and lower lobes of the left lung. The aneurysm had ruptured, causing blood and pus to accumulate in the left pleural cavity and severely damaging vital structures, including the bronchus and mediastinum.

Assoc. Prof. Dr. Vu Huu Vinh, PhD noted that this was an extremely rare and easily misdiagnosed condition, often mistaken for a lung tumor. Without timely surgical intervention, the patient would have faced an imminent risk of death.

Meticulous preparation for high-risk surgery

Given the life-threatening situation, a multi-disciplinary hospital-wide case meeting was convened, including senior physicians from the Emergency, Anesthesiology, and Intensive Care Units… with Assoc. Prof. Dr. Vu Huu Vinh, PhD. A detailed pre-, intra-, and post-operative plan was developed to minimize surgical risks and avoid catastrophic bleeding.

Prior to surgery, Dr. Vinh and the anesthesiology team inserted a multi-lumen central venous catheter and an arterial line. These measures ensured real-time blood pressure monitoring, rapid blood sampling, and simultaneous administration of medications, fluids, and blood products. Monitoring of central venous pressure (CVP) also provided essential hemodynamic insights throughout the operation.

A three-hour, high-stakes procedure

The surgery began at 3:00 p.m. with a preoperative team briefing to assign clear roles and responsibilities. Upon opening the thoracic cavity, the surgeons encountered adhesions between the left lung and chest wall, along with thick yellow fluid and pseudomembranes that impeded access. A massive 15×15 cm lesion was found in the lower lobe, pulsating visibly with each heartbeat and tightly adhered to the upper lobe, requiring precise and delicate dissection.

The situation became even more critical when the aneurysmal pulmonary artery was found to be fragile, jagged-edged, and adherent to surrounding tissues — posing a constant risk of rupture and massive hemorrhage. Additionally, the lingular and upper lobe bronchi were severely damaged, with softened and necrotic tissue increasing the risk of lung collapse and ventilation failure. Controlling infection and ensuring patient safety were key challenges.

Despite these difficulties, Dr. Vinh and his surgical team successfully controlled the bleeding and infection caused by the ruptured aneurysm, which had nearly destroyed the entire left lung. They removed all necrotic tissue and pseudomembranes to prevent the spread of infection. With surgical precision and over 30 years of experience, Assoc. Prof. Dr. Vu Huu Vinh, PhD successfully excised the aneurysm and stabilized the patient.

Ultimately, a complete left pneumonectomy was performed. The pleural cavity was thoroughly irrigated to minimize postoperative infection risk. The team also carefully adjusted the mediastinum to prevent sudden shifts — a potentially fatal complication that could disrupt cardiopulmonary function after surgery.

Patient stabilizes postoperatively

Three days after the operation, the patient was in stable condition and continued recovering under close monitoring by the hospital team. The surgery was considered a remarkable success, especially given the extent of damage involving the entire left lung.

This was one of the most complex thoracic surgery cases ever handled at Nam Sai Gon International General Hospital. The patient’s life was saved thanks to the decisive actions of the hospital leadership and the expertise of Assoc. Prof. Dr. Vu Huu Vinh, PhD — a leading thoracic surgeon with over 30 years of experience in Vietnam.

Doctor’s recommendation:

Dr. Vinh advised that patients should seek medical attention promptly if they experience symptoms such as chest pain, shortness of breath, or other abnormalities. Timely diagnosis and treatment are crucial to preventing life-threatening complications.

Nam Sai Gon International General Hospital

No. 88, Street No. 8, Trung Son Residential Area, Binh Hung Commune, Ho Chi Minh City.

Hotline: 18006767

info@nih.com.vn

BRC: No. 0312088602, issued on December 14th, 2012 by the Department of Planning and Investment of Ho Chi Minh City. Medical Examination and Treatment License No. 230/BYT-GPHĐ, issued by the Ministry of Health.