What type of sternotomy is typically used for lung transplant?
Transverse (clamshell) sternotomy. This technique provides excellent exposure to the hila, lower lobes, and allows access for cardiopulmonary bypass cannulation. Clamshell sternotomy is typically reserved for lung transplant and bilateral pleural adhesion division. This compares to median sternotomy which is typically used for unilateral procedures such as valve replacement or CABG where anterior exposure is required.
Why did this patient get a left pneumothorax?
Interpleural communication post clamshell thoracotomy is the most likely cause however bilateral airways dehiscence is also a consideration. Interpleural communication can be seen rarely as an anatomical variant or "buffalo chest" owing to the presence of interpleural communication in North American buffalos (bison).
Anastomotic dehiscence post transplant CXR
- new right haemopneumothorax is most concerning for airway dehiscence
- pneumothorax suggests airway dehiscence and stump-plerual fistula
- vascular compromise can be confirmed on contrast enhanced CT
- the term "stump" dehiscence is often used but can cause confusion as it doesn't discriminate between pulmonary arterial, bronchial arterial, or airways dehiscence
- new left pneumothorax
- tubes and lines appropriately positioned (see above)
- tracheostomy
- NGT
- right Vascath
- left PICC line
- chest tubes