Post pneumonectomy syndrome
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Postpneumonectomy syndrome is a delayed complication seen primarily in children and young adults within a year after surgery. Most cases of postpneumonectomy syndrome have been described as occurring after right pneumonectomy, when the powerful negative pressure of the involved hemithorax and over-expansion of the remaining lung move the mediastinum rightward. The frequency with which this syndrome occurs in infants, young children, and women is believed to be related to the increased elasticity and compliance of their lungs and mediastinum, compared with those of older patients and men.
Diagnosis
The syndrome is manifested in exertional dyspnea, inspiratory stridor, and recurrent pulmonary infections.
Imaging findings are,
- Overexpanding lung displacing the mediastium away from it.
- CT images show abnormal narrowing of the distal part of the trachea and the left main bronchus because of compression of the airway between the pulmonary artery anteriorly and the aorta and spine posteriorly.
- As the overexpanded lung further displaces the mediastinum toward the right side, the heart descends in the hemithorax and rotates counterclockwise along its main axis.
- The trachea also is displaced toward the right side, with resultant stretching of the left main bronchus, which is compressed downward by the aortic arch and the left main pulmonary artery.
Treatment
Various surgical procedures have been used to reposition the mediastinum. Silicone breast implants have been used in the postpneumonectomy space to prevent rotational shifting after pneumonectomy in children, a method that has brought good results.