Post-pneumonectomy syndrome

A rare
surgical outcome - post pneumonectomy syndrome. Right deviation of the trachea. Hypotransparency of the lower half of the right hemithorax. Displacement of the cardiac silhouette. There is evidence of aired lung in the right hemithorax since vascular markings are clearly seen.
www.eurorad.org • CC by-nc-sa-4.0
A rare
surgical outcome - post pneumonectomy syndrome. Left pulmonar artery (red arrow) compressing the distal trachea (blue arrow) against the vertebral body.
www.eurorad.org • CC by-nc-sa-4.0
A rare
surgical outcome - post pneumonectomy syndrome. Counterclockwise rotation of the mediastinum and hyperinflation and herniation of the left lung. Note the stretching of the left bronchus (red arrow).
www.eurorad.org • CC by-nc-sa-4.0
A rare
surgical outcome - post pneumonectomy syndrome. Narrowing of distal trachea due to compression of the left pulmonary artery. Shift in major vessel positioning.
www.eurorad.org • CC by-nc-sa-4.0
A rare
surgical outcome - post pneumonectomy syndrome. Presence of mucus within the bronchus (red arrow). Crowding of ribs: The interspace between ribs on the right is narrower compared to the opposite side.
www.eurorad.org • CC by-nc-sa-4.0
A rare
surgical outcome - post pneumonectomy syndrome. Chest radiograph. After a pneumonectomy, the resulting resection cavity fills with fluid. No aerated lung is depicted in the right hemithorax. The cardiac silhouette shifted rightwards to fill the space vacated by the removed lung.
www.eurorad.org • CC by-nc-sa-4.0
A rare
surgical outcome - post pneumonectomy syndrome. CT scan - axial view. Right hemithorax cavity filled with fluid after right pneumonectomy. There is mild rightward deviation of the mediastinum and hyperinflation of the remaining lung.
www.eurorad.org • CC by-nc-sa-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Post-pneumonectomy syndrome is delayed complication of pneumonectomy characterized by respiratory compromise caused by severe mediastinal shift and counterclockwise rotation of the heart and great vessels.

Epidemiology

Rare delayed complication of pneumonectomy, which more commonly involves the left main stem bronchus after a right pneumonectomy. Very rarely it involves the right main stem bronchus post left pneumonectomy in the presence of a right aortic arch.

It primarily involves children and young adults and women within a year after surgery, probably related to increased elasticity and compliance of their lungs and mediastinum in these groups, compared with older patients and men.

Clinical presentation

Symptoms include exertional dyspnea, inspiratory stridor, and recurrent cases of pneumonia.

Radiographic features

Plain radiograph

May show a completely opacified involved hemithorax with ipsilateral mediastinal shift. Surgical clips may be identified at the lung hilum or resected lung.

CT

This is the modality of choice for diagnosis. It better demonstrates the plain radiographic findings and may additionally show abnormal stretching and narrowing of the distal part of the trachea and the left main bronchus that is entrapped between the pulmonary artery anteriorly and the aorta and spine posteriorly. May also show the heart descending in the involved hemithorax and rotated counterclockwise along its main axis.

Treatment and prognosis 

Several surgical options described; the main aim is to reposition the mediastinal structures to the midline. One of the options is Silicone breast implants have been used in the involved pleural  space to prevent ipsilateral rotational shifting of mediastinum.

Siehe auch:
Assoziationen und Differentialdiagnosen zu Post-Pneumonektomie-Syndrom:
Mediastinalshift
 
Wikipedia • CC BY-SA 3.0