Last revised by Daniel J Bell on 15 May 2021

Pneumonectomy is a radical lung surgery involving complete surgical removal of the lung. It is most commonly performed for primary lung malignancy. The lung is removed in its entirety providing the patient has adequate pulmonary reserve from the contralateral lung.

Recognized post-pneumonectomy complications include:

Radiographic features

The typical course of possible appearances on imaging following pneumonectomy are:

  • acutely, there is partial filling of the hemithorax with a combination of fluid, air/gas and contralateral lung and mediastinum
  • mediastinal shift occurs gradually accompanied by hyperinflation of the contralateral lung and herniation
  • sequential chest radiographs should demonstrate increasing fluid and decreasing gas within the pneumonectomy space, which is evident by a gas-fluid level which gradually rises
    • if the gas-fluid level starts to lower, a bronchopleural fistula is suspected
  • sequential chest radiographs should demonstrate gradual volume loss on the pneumonectomy side
Plain radiograph

Pneumonectomy is one of the causes of a white out of the hemithorax. The hemithorax is completely opacified with the trachea pulled towards the side of the abnormality. Surgical clips may be identified at the lung hilum.


The lung is absent on the side of surgery, with resultant mediastinal shift and compensatory hyperinflation of the contralateral lung.

See also

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3: early findings
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  • Case 4
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  • Case 5
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  • Case 6: CT right-sided pneumonectomy
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  • Case 7
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  • Case 8: left side
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