Endobronchial Stent Placement for Treatment of Left Postpneumonectomy Syndrome

Abstract

Postpneumonectomy syndrome is a rare complication, seen more commonly after right-side pneumonectomy than left-side pneumonectomy. It is characterized by a shift and rotation of the heart and mediastinum into the empty hemithorax, leading to marked hyperinflation of the remaining lung. The distal end of the trachea or mainstem bronchus becomes stretched and compressed extrinsically between the pulmonary artery anteriorly and the aorta or thoracic vertebrae posteriorly. The syndrome is manifested by dyspnea, cough, stridor, and recurrent pneumonia. We present a 42-year-old woman who presented with complaints of exercise intolerance 7.5 years after a left pneumonectomy. Chest radiography and computed tomography of the thorax were consistent with postpneumonectomy syndrome. Pulmonary function tests demonstrated severe obstructive and restrictive ventilatory defects, which was markedly worse than several months after the surgery. On visualization by flexible bronchoscopy, the right bronchus intermedius appeared notably narrowed and fish-mouthed, secondary to extrinsic compression. The patient was treated with an endobronchial stent to relieve the external compression of the bronchus intermedius. The patient demonstrated marked objective and subjective improvement.