Abstract
Selective isolation of a pulmonary lobe is indispensable in patients who have undergone pneumonectomy and require surgery of the remaining lung. The use of a bronchial blocker is associated with the following problems: 1) placement can require considerable time; 2) suction is often necessary to expedite lung collapse; and 3) the position of the blocker sometimes must be corrected intraoperatively with the use of fiberoptic bronchoscopy. To solve these problems, it is useful for physicians to simulate the positioning of blockers on preoperative coronal multiplanar reformation images obtained by 64- slice multidetector computed tomography (MDCT) and to be familiar with airway devices for lung isolation. We describe the use of selective lobar blockade with an endobronchial blocker assisted by preoperative coronal multiplanar reformation images on 64-MDCT in a patient who had undergone a left pneumonectomy.
Highlights
Selective isolation of a pulmonary lobe is indispensable in patients who have undergone pneumonectomy and require surgery of the remaining lung
A coronal multiplanar reformation image was obtained from the CT volume data, allowing the bronchial system to be continuously displayed from the tracheal bifurcation to the cavitary mass in the right middle lobe on a single slice image
Selective lobar blockade is necessary in patients who have undergone pneumonectomy and require thoracic surgery involving the remaining lung
Summary
Selective isolation of a pulmonary lobe is indispensable in patients who have undergone pneumonectomy and require surgery of the remaining lung. A coronal multiplanar reformation image was obtained from the CT volume data, allowing the bronchial system to be continuously displayed from the tracheal bifurcation to the cavitary mass in the right middle lobe on a single slice image. It was advanced and positioned in the orifice of the right middle bronchus, and the balloon was inflated with 4 mL of air while monitoring the procedure with a 2.8-mm outer diameter fiberscope (Karl Storz, Tokyo, Japan).
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