Presentation
Clinical presentation Postpneumonectomy syndrome is a rare late complication of pneumonectomy, with patients presenting up to 20 years after the initial operation (5). [shc.amegroups.com]
Four presented with a right PPS and two with a left PPS, respectively. Symptoms consisted of shortness of breath in all patients and dysphagia as well as heartburn in two patients. [pubmed.ncbi.nlm.nih.gov]
Assisted ventilation COPD exacerbations non-invasive ventilation bronchiectasis lung cancer A 47-year-old woman presented with exertional dyspnoea, cough, nausea and weight loss 2 years after a right pneumonectomy for non-small cell lung cancer. [thorax.bmj.com]
Respiratoric
- Stridor
Symptoms include exertional dyspnea, inspiratory stridor, and recurrent cases of pneumonia. Plain radiograph May show a completely opacified involved hemithorax with ipsilateral mediastinal shift. [radiopaedia.org]
Symptoms are manifold and result from a shift, leading to compression and stretching of the two conduits located within the mediastinum, the tracheobronchial tree and the esophagus and consists of shortness of breath, stridor and heartburn. [pubmed.ncbi.nlm.nih.gov]
Surgical correction of postpneumonectomy stridor by saline breast implantation. Ann Thorac Surg 2001;71:1704-6. [Crossref] [PubMed] Lloyd MS, Wallis C, Muthialu N, et al. [shc.amegroups.com]
- Dyspnea
Symptoms include exertional dyspnea, inspiratory stridor, and recurrent cases of pneumonia. Plain radiograph May show a completely opacified involved hemithorax with ipsilateral mediastinal shift. [radiopaedia.org]
Figure 2 A 14-year-old patient with postpneumonectomy syndrome after carinal pneumonectomy for obstructing carcinoid tumor of the right main bronchus presented with persistent cough and dyspnea. [shc.amegroups.com]
- Pneumonia
Symptoms include exertional dyspnea, inspiratory stridor, and recurrent cases of pneumonia. Plain radiograph May show a completely opacified involved hemithorax with ipsilateral mediastinal shift. [radiopaedia.org]
[…] recent large series published in 2008, operative mortality was 5.6% (1 patient out of 18 died of multiorgan system failure after aortic division and bypass in a patient with recurrent postpneumonectomy syndrome) and postoperative complications such as pneumonia [shc.amegroups.com]
- Cough
Assisted ventilation COPD exacerbations non-invasive ventilation bronchiectasis lung cancer A 47-year-old woman presented with exertional dyspnoea, cough, nausea and weight loss 2 years after a right pneumonectomy for non-small cell lung cancer. [thorax.bmj.com]
Figure 2 A 14-year-old patient with postpneumonectomy syndrome after carinal pneumonectomy for obstructing carcinoid tumor of the right main bronchus presented with persistent cough and dyspnea. [shc.amegroups.com]
- Inspiratory Stridor
Symptoms include exertional dyspnea, inspiratory stridor, and recurrent cases of pneumonia. Plain radiograph May show a completely opacified involved hemithorax with ipsilateral mediastinal shift. [radiopaedia.org]
Gastrointestinal
- Dysphagia
Symptoms consisted of shortness of breath in all patients and dysphagia as well as heartburn in two patients. [pubmed.ncbi.nlm.nih.gov]
Excessive traction and compression of mediastinal structures can produce gas trapping, dysphagia and reflux, recurrent laryngeal nerve palsy, tracheomalacia and vascular compromise.3 Surgical implantation of tissue expanders to reduce mediastinal shift [thorax.bmj.com]
Rarely, patients can present with progressive dysphagia from compression of the esophagus between the heart and aorta (4) or aorta and inferior vena cava (9). [shc.amegroups.com]
Workup
X-Ray
- Mediastinal Shift
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. [radiopaedia.org]
CT demonstrated marked mediastinal shift and herniation of the left lung into the pneumonectomy cavity (figure 1A). [thorax.bmj.com]
It consists of an excessive mediastinal shift resulting in compression and stretching of the tracheobronchial tree and the esophagus. [pubmed.ncbi.nlm.nih.gov]
Review Article Introduction Postpneumonectomy syndrome refers to a constellation of symptoms from airway compression due to mediastinal shifting after pneumonectomy. [shc.amegroups.com]
Treatment
Implantation of prosthesis is the most commonly used and effective treatment. [pubmed.ncbi.nlm.nih.gov]
Treatment Once postpneumonectomy syndrome has been diagnosed, treatment should follow promptly to avoid the long-term sequelae of postpneumonectomy syndrome and the acute presentation of respiratory distress. [shc.amegroups.com]
Treatment and prognosis Several surgical options described; the main aim is to reposition the mediastinal structures to the midline. [radiopaedia.org]
Prognosis
Treatment and prognosis Several surgical options described; the main aim is to reposition the mediastinal structures to the midline. [radiopaedia.org]
Prevention
One of the options is silicone breast implants which have been used in the involved pleural space to prevent ipsilateral rotational shifting of mediastinum. References Promoted articles (advertising) [radiopaedia.org]
[…] excessive mediastinal shift;4 ,5 however, there are no published data examining methods to prevent this complication. [thorax.bmj.com]
Prevention of postpneumonectomy syndrome in children with prophylactic tissue expander insertion. J Pediatr Surg 2012;47:1354-7. [Crossref] [PubMed] Wang B, Tan S, Yu F. [shc.amegroups.com]