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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.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf461","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T20:55:32Z","timestamp":1751662532000},"source":"Crossref","is-referenced-by-count":0,"title":["Air leakage directly into dissected upper mediastinum following right upper lobectomy"],"prefix":"10.1093","volume":"2025","author":[{"given":"Masashi","family":"Nagata","sequence":"first","affiliation":[{"name":"Department of General Surgery, Okinawa Kyodo Hospital , 4-10-55 Kohagura, Naha 900-8558 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Miyagi","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Okinawa Red Cross Hospital , 1-3-1 Yogi, Naha 902-8588 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihiko","family":"Kanai","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Jichi Medical University , 3311-1 Yakushiji, Shimotuke, Tochigi 329-0498 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinichi","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Jichi Medical University , 3311-1 Yakushiji, Shimotuke, Tochigi 329-0498 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyoshi","family":"Tsubochi","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Jichi Medical University , 3311-1 Yakushiji, Shimotuke, Tochigi 329-0498 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunsuke","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of 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