Postpneumonectomy syndrome: Surgical management and long-term results

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Presentation transcript:

Postpneumonectomy syndrome: Surgical management and long-term results K. Robert Shen, MD, John C. Wain, MD, Cameron D. Wright, MD, Hermes C. Grillo, MD, Douglas J. Mathisen, MD The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 6, Pages 1210-1219.e6 (June 2008) DOI: 10.1016/j.jtcvs.2007.11.022 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Representative preoperative bronchoscopic appearance of the trachea and left main bronchus in postpneumonectomy syndrome after a right pneumonectomy. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1210-1219.e6DOI: (10.1016/j.jtcvs.2007.11.022) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Preoperative bronchoscopy in a 39-year-old woman (patient 11) who developed postpneumonectomy syndrome after right pneumonectomy 1 year earlier. The left lower lobe bronchus (arrows) has been almost completely compressed. B, Postoperative bronchoscopy showing widely patent lobar orifices. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1210-1219.e6DOI: (10.1016/j.jtcvs.2007.11.022) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Postpneumonectomy syndrome in a 20-year-old woman (patient 16) who underwent right pneumonectomy for carcinoid 4 years earlier. She developed postpneumonectomy syndrome within 1 year of pneumonectomy and had mediastinal repositioning with breast implants. Recurrent symptoms developed after one of the implants ruptured. The patient underwent reoperation with placement of Lucite balls. A, Chest roentgenogram shows heart and mediastinum displaced to the right with obliteration of the right pleural space. The lung is hyperexpanded and herniated, and numerous plombage balls can be seen. B, Lateral view demonstrates posterior displacement of mediastinal contents. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1210-1219.e6DOI: (10.1016/j.jtcvs.2007.11.022) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

A, Computed tomography scan of the same patient shows shift of the mediastinum to the right and posteriorly with compression of the left mainstem bronchus between the pulmonary artery and the aorta. B, Despite the presence of numerous prostheses, the mediastinum is shifted into the pneumonectomy space. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1210-1219.e6DOI: (10.1016/j.jtcvs.2007.11.022) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

At the time of the third corrective operation, numerous Lucite plombage balls were removed from the pneumonectomy space and replaced with saline-filled breast implants. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1210-1219.e6DOI: (10.1016/j.jtcvs.2007.11.022) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Computed tomography scan after third corrective operation Computed tomography scan after third corrective operation. Lung herniation has been corrected, and the mediastinum is in the central position with the left main bronchus to the left of the spine. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1210-1219.e6DOI: (10.1016/j.jtcvs.2007.11.022) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions