Management of empyema complicating lobectomy with superior vena cava replacement

We present the case of a 49-year-old man with right upper lobe adenocarcino ma invading the right brachiocephalic vein and the origin of the superior v ena cava. En bloc resection of right upper lobe with the involved venous se gments was carried out through a median sternotomy. Venous pathway was rees tablished with a Gore-Tex (W.L. Gore gr Assoc, Flagstaff, AZ) prosthesis. P ostoperative course was marked by right pneumonia complicated by empyema. T he patient underwent thoracotomy with completion pneumonectomy and latissim us dorsi transposition to cover both the prosthesis and the bronchial stump , as well as to fill the cavity. A favorable outcome was observed and long- term survival achieved. (Ann Thorac Surg 2000;70:1720-1) (C) 2000 by The So ciety of Thoracic Surgeons.