Persistent Air Leak Post-Lobectomy — FRCA Final MCQ

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ModerateCardiothoracic AnaesthesiaPersistent Air Leak Post-LobectomyFRCA Final

A 65-year-old man (ASA III, 80 kg) with chronic obstructive pulmonary disease undergoes right upper lobectomy via VATS. Postoperatively he develops a persistent air leak from the chest drain for 5 days. What is the most likely source of the air leak?

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Correct answer: E — Alveolar-pleural fistula from the staple line

A persistent air leak (PAL) after lung resection most commonly arises from the staple line or raw lung surface where alveoli communicate with the pleural space (alveolar-pleural fistula). This is the most common complication after lobectomy, occurring in 8-15% of cases. Risk factors include: emphysematous lung disease, incomplete fissures, and upper lobectomy. Management: maintain chest drainage on underwater seal (or digital drainage system), minimise positive pressure ventilation, consider pleurodesis if persistent beyond 5-7 days. A true bronchopleural fistula (BPF) is rarer and more serious.

Reference: RCOA – 2023 – Cardiothoracic module; BTS – 2023 – Pleural disease guidelines