A 67-year-old man got through lung cancer surgery without major problems. About eight months later, three seemingly unrelated symptoms appeared: palpitations, a tight throat and a stuffy nose. All three got worse when he was upright and eased when he lay flat.
Doctors at the Clinical Oncology Center of the University of Hong Kong-Shenzhen Hospital in China described his case in an April 2026 report in the Journal of Medical Case Reports. They called it "a peculiar triad" of symptoms, one that, to their knowledge, had not been previously reported after lobectomy.
The symptoms worsened for several months, peaked about a year after surgery, and had resolved on their own by 17 months. The authors suspect the explanation lies in how his chest rearranged itself to fill the space the removed lung tissue left behind.
Two Cancers, Two Lobes Removed
The man had two separate primary lung cancers on the right side: a squamous cell carcinoma in the lower lobe and an adenocarcinoma in the middle lobe. Both were early stage, and a PET-CT scan showed no distant spread. Surgeons removed both lobes in a single-port thoracoscopic (keyhole) operation, leaving only the upper lobe of his right lung.
When it can be done, lobectomy is often the preferred operation for non-small cell lung cancer, according to the American Cancer Society. The society estimates about 229,410 new U.S. lung cancer cases in 2026, and about 77% of lung cancers are the non-small cell type.
His early recovery had some bumps, including a mild pneumothorax (air around the lung), partial lung collapse, and fluid in the chest. These resolved with rehabilitation. He stopped planned chemotherapy after three cycles because he could not tolerate it.
Standing Up Changed His Heart Rate
The new symptoms came months later. When he stood, his blood pressure dropped and his heart raced, a pattern known as orthostatic hypotension with sinus tachycardia. When he lay down, his heart rate slowed again.
Multiple consultations attributed the problem to "pulmonary compensation." No medicine was reported for the symptoms. He continued respiratory therapy, and the triad eventually resolved on its own.
A CT scan one year after surgery showed how much his chest had changed. The remaining upper lobe had enlarged to fill the space. The mediastinum, the central compartment holding the heart, windpipe, and major vessels, had shifted. The spaces between his right ribs had narrowed, and the right side of his diaphragm had risen.
A Shifted Chest and Gravity
The authors offer a hypothesis rather than proof. As fluid and air left after surgery were absorbed, they propose, negative pressure inside the chest pulled the diaphragm up, drew the ribs together, and pulled the mediastinum toward the operated side.
Standing may have added gravity to that shift. The authors suggest gravity "may have accentuated mediastinal displacement and cardiac micro-movement," briefly changing how blood returned to the heart and provoking the palpitations and throat tightness. Pulling on the windpipe and throat, they add, may have produced a "referred sensation" of nasal congestion.
They are careful about how far this goes. They call the proposed links "speculative and hypothesis-generating rather than established pathophysiology" and acknowledge that "direct evidence is lacking in our single case."
Something similar is well documented after removal of an entire lung. In postpneumonectomy syndrome, the heart and mediastinum swing into the empty side of the chest and can compress the airway. A review in Shanghai Chest notes that most reported cases followed removal of the right lung. A comparable problem after lobectomy is rarely reported. A 2019 case report in Annals of Translational Medicine noted that only three such cases after lobectomy had appeared in the literature.
Orthostatic intolerance soon after lung surgery is not rare. A 2024 study in BMC Surgery found it in about 30% of 215 patients during early mobilization, roughly a day after thoracoscopic lung resection. This man's symptoms, however, began eight months later.
The Recovery Did Not End There
The postural symptoms were not his only late problem. Over two years, his weight fell from 60.6 kilograms to 40.1 kilograms, even though he was eating heavily, including frequently at night. His lungs also struggled to clear carbon dioxide, and testing showed compensated hypercapnic respiratory failure. Starting around 17 months after surgery, he had episodes of disorientation, agitation, and impulsive behavior. Brain imaging and other tests did not find cancer spread, infection, or stroke.
A two-year CT showed destructive overinflation of his remaining right lung, with air-filled pockets called bullae. After a bout of pneumonia, he was treated with antibiotics, and his breathing and mental state improved once his low oxygen was corrected. More than three years after surgery, he remains free of cancer, the postural triad is gone, and his weight has partly recovered, though mild psychiatric symptoms persist.
The authors argue that "delayed complications are under-recognised." They call for more comprehensive functional assessment before surgery, lung-sparing operations when appropriate, and prolonged follow-up by several specialties. In their view, surgical success should be judged not only by how the operation went but by a patient's later functional and psychosocial course.
A single case cannot show how often such symptoms occur. People recovering from lung surgery who develop new symptoms that change with posture should report them to their surgical or oncology team instead of assuming they are normal.
Key Questions Answered
What happened to the patient?
About eight months after his right middle and lower lung lobes were removed for cancer, a 67-year-old man developed palpitations, throat tightness, and nasal congestion that worsened upright and eased lying flat.
What did his scans show?
His remaining lung lobe had enlarged, his mediastinum had shifted, the spaces between his right ribs had narrowed, and the right side of his diaphragm had risen.
Did the symptoms go away?
Yes. They peaked about 12 months after surgery and resolved on their own by 17 months.
What caused them?
The authors suspect that the shifted chest structures, accentuated by gravity when standing, altered blood return to the heart and pulled on the windpipe and throat. They stress that this is unproven.
Is this common after lobectomy?
The authors say that, to their knowledge, this combination had not been reported after lobectomy before. A single case cannot establish how often it happens.
What should patients do if they notice similar symptoms?
Report new or posture-related symptoms to the surgical or cancer care team so they can be evaluated.
Published by Medicaldaily.com
