Pulmonary endarterectomy and lung resection achieving therapeutic success in rarely encountered large cavitary infarctions following pulmonary embolism: a case report

BACKGROUND: Cavitary infarction following pulmonary embolism is a rare condition associated with high mortality. Surgical intervention is mainly indicated in cases where medical therapy has failed. Although previous reports have shown promising results of surgical management, we have found only 15 cases reported in the literature where surgery was undertaken. To the best of our knowledge, we report the first case in which pulmonary endarterectomy combined with lung resection were successfully performed to manage this rare high-risk condition. CASE PRESENTATION: 44-year-old man presented with a 2-week history of cough, fever, nausea and vomiting, as well as significant weight loss. Investigations revealed cavitating lesions and acute pulmonary embolism for which he was initially started on antibiotics and anticoagulation, followed by surgery. This included right upper lobectomy, wedge resection from the right lower lobe, and pulmonary endarterectomy. He was discharged home in satisfactory condition on his 13th postoperative day. CONCLUSIONS: In this case, early surgery demonstrated both safety and efficacy in managing this high-risk rare condition. Involving the multi-disciplinary team and combining surgical intervention with appropriate antibiotics and anticoagulation regimes in a multi-modal approach is key to offer the best management to this group of sick patients.