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A 58-year-old male was diagnosed with a right upper lobe lung adenocarcinoma, stage IIIA (T4 N1 M0). Based on the multidisciplinary team’s conclusion, the patient underwent neoadjuvant chemoimmunotherapy (nivolumab, carboplatin and paclitaxel) followed by surgery (right thoracotomy with right upper lobectomy, atypical middle lobe resection, partial resection of the fourth and fifth ribs and mediastinal lymph node dissection). On the first postoperative day, chest X-ray revealed an opacity in the right middle lobe (figure 1A), and 950 mL of haemorrhagic fluid was evacuated through the chest drain. Laboratory findings showed a slight haemoglobin drop to 106 g/L, along with mild leucocytosis (10.4×10⁹/L) and elevated C-reactive protein (136 mg/L). The patient remained afebrile. On the second postoperative day, a chest X-ray demonstrated complete consolidation of the middle lobe that obtained an oval-shaped configuration, accompanied by a right-sided pneumothorax, pneumomediastinum and subcutaneous emphysema (figure 1B).