Unusual cause of dyspnea after pneumonectomy

Abstract

The patient was readmitted to the hospital 2 weeks after surgery because of increasing shortness of breath. He had not experienced paroxysmal nocturnal dyspnea, orthopnea, angina, or symptoms of acute cardiac decompensation. The patient’s oxygen saturation was 90% while breathing room air, his pulse was regular at 80 beats/min, and his blood pressure was 130/70 mmHg. There were no signs of heart failure. The trachea was central to the suprasternal notch on palpation. Chest examination revealed dullness to percussion and auscultation on the left side and good aeration on the right side. An electrocardiogram revealed no changes in a right bundlebranch block that was seen preoperatively. Levels of cardiac enzymes (troponin-I and creatine kinase-MB) were normal. Computed tomography and computed tomography angiography of the chest showed no evidence of pulmonary embolism or pulmonary infection. Positive findings included a small rightsided pleural effusion, mild emphysematous changes in the right lung, and near-complete filling with fluid of the pleural space within the left hemithorax. A portable chest radiograph was also obtained, and the image is shown in Fig 1. What was the diagnosis?