Air leakage directly into dissected upper mediastinum following right upper lobectomy

Postoperative subcutaneous emphysema (SE) can sometimes lead to clinical complications, mainly due to abnormal air leakage (AL) into the chest wall through the surgically breached parietal pleura. In this report, we describe a patient who, following a right upper lobectomy and upper mediastinal dissection, developed progressive mediastinal and SE on postoperative day 6, which persisted despite thoracostomy. Reoperation indicated AL from the resected interlobular plane directly into the upper mediastinum through dense adhesions. These adhesions were released, and the leakage site was re-sealed. Subsequently, the emphysema regressed. This report presents a unique route of airflow that may occur especially following right upper lobectomy, highlighting the importance of surgical treatment and AL prevention strategies in such cases.