Post-pneumonectomy syndrome

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 right pneumonectomy, and very rarely post left pneumonectomy that occurs in the case of coexisting 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.

Plain radiograph

May show a completely opacified involved hemithorax with ipsilateral mediastinal shift and  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.

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.

Share article

Article information

rID: 52968
System: Chest
Section: Syndromes
Synonyms or Alternate Spellings:
  • Post pneumonectomy syndrome

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Case 1
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.