Abstract
IntroductionPostpneumonectomy syndrome is a rare condition that is characterized by dyspnea resulting from an extreme mediastinal shift and bronchial compression of the residual lung following surgical pneumonectomy. It is even rarer for this syndrome to present in patients without a history of prior lung surgery but induced by autopneumonectomy due to parenchymal disease, an entity termed ‘postpneumonectomy-like syndrome’.Case presentationWe present a rare case of a 91-year-old Puerto Rican man presenting with progressively worsening dyspnea with a history of pulmonary tuberculosis diagnosed 40 years earlier who developed severe unilateral lung fibrosis. Plain X-ray and computed tomography scans confirmed the presence of postpneumonectomy-like syndrome secondary to his parenchymal lung destruction. The patient developed cor pulmonale due to his extensive lung disease and as a consequence was not a suitable candidate for surgical intervention. The patient was otherwise stable until he developed acute respiratory distress from an acute upper gastrointestinal bleed and died four days into his hospital course.ConclusionWe present a rare case of postpneumonectomy-like syndrome as sequelae of severe pulmonary parenchymal tuberculosis infection along with a review of literature, in the hopes of aiding clinicians to include the differential of postpneumonectomy-like syndrome in patients presenting with worsening dyspnea without a history of surgical lung resection.
Highlights
Postpneumonectomy syndrome is a rare condition that is characterized by dyspnea resulting from an extreme mediastinal shift and bronchial compression of the residual lung following surgical pneumonectomy
We present a rare case of postpneumonectomy-like syndrome as sequelae of severe pulmonary parenchymal tuberculosis infection along with a review of literature, in the hopes of aiding clinicians to include the differential of postpneumonectomy-like syndrome in patients presenting with worsening dyspnea without a history of surgical lung resection
Postpneumonectomy-like syndrome is an uncommon complication of autopneumonectomy secondary to destructive lung disease [1,2,3]
Summary
The features of postpneumonectomy syndrome typically present after a patient has undergone surgical lung resection and seldom occur secondary to a fibrotic lung. We present a rare case of a patient presenting with postpneumonectomy-like syndrome secondary to destructive pulmonary tuberculosis that resulted in a right-sided autopneumonectomy. This patient was not a candidate for surgical intervention due to his age and health status and, as a result, was managed conservatively. JD has made substantial contributions to conception and design of the manuscript, has been involved in revising it critically for important intellectual content and contributed in writing the manuscript. MA, AK, RM made substantial contributions to conception and design of the manuscript and have been involved in revising it critically for important intellectual content. Michael’s Medical Center, 111 Central Ave., Newark, NJ 07102, USA. 2Division of Pulmonary and Critical Care Medicine, St Michael’s Medical Center, Seton Hall University, Newark, NJ, USA. 3Department of Internal Medicine, St Michael’s Medical Center, Seton Hall University, Newark, NJ, USA
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