Post-pneumonectomy syndrome is delayed complication of pneumonectomy characterised by respiratory compromise caused by severe mediastinal shift and counterclockwise rotation of the heart and great vessels.
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.
Symptoms include exertional dyspnoea, inspiratory stridor, and recurrent cases of pneumonia.
May show a completely opacified involved hemithorax with ipsilateral mediastinal shift and Surgical clips may be identified at the lung hilum or resected lung.
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.
- 1. Chae EJ, Seo JB, Kim SY, Do KH, Heo JN, Lee JS, Song KS, Song JW, Lim TH. Radiographic and CT findings of thoracic complications after pneumonectomy. Radiographics : a review publication of the Radiological Society of North America, Inc. 26 (5): 1449-68. doi:10.1148/rg.265055156 - Pubmed
- 2. Quillin SP, Shackelford GD. Postpneumonectomy syndrome after left lung resection. Radiology. 179 (1): 100-2. doi:10.1148/radiology.179.1.2006258 - Pubmed
- 3. Soll C, Hahnloser D, Frauenfelder T, Russi EW, Weder W, Kestenholz PB. The postpneumonectomy syndrome: clinical presentation and treatment. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 35 (2): 319-24. doi:10.1016/j.ejcts.2008.07.070 - Pubmed
- 4. Chandrashekhara SH, Bhalla AS, Sharma R, Gupta AK, Kumar A, Arora R. Imaging in postpneumonectomy complications: a pictorial review. Journal of cancer research and therapeutics. 7 (1): 3-10. doi:10.4103/0973-1482.80426 - Pubmed