Postoperative diffused alveolar hemorrhage complicated by pneumonia after lung cancer surgery in a patient with liver cirrhosis: a case report and review of literatures

Postoperative pulmonary complications remain a challenge after pulmonary surgery in patients with severe cirrhosis in spite of advances in perioperative management. Diffused alveolar hemorrhage (DAH) is a pernicious clinical syndrome that is often primarily assumed to be atypical pneumonia. We report a case of a 54-year-old man presented with shortness of breath on the first post-operation day, who was successfully treated by left superior segmentectomy and right superior wedge resection. Imaging studies showed patchy infiltrates scattered throughout both lungs. Klebsiella pneumoniae and Candida albicans were found in the sputum culture. Management strategy was designed to provide adequate respiratory support, treat underlying infections and control inflammation. Non-invasive ventilator assisted ventilation was performed. We proposed that cirrhosis-induced DAH should be considered in the differential diagnosis of early pulmonary complications after pulmonary surgery. Early diagnosis and proper but not aggressive treatment protocol are crucial for recovery.