Postpneumonectomy Syndrome Research Articles

SF6 is a useful expander for post-pneumonectomy syndrome in the long-term course: a case report

BackgroundPost-pneumonectomy syndrome (PPS) is a rare but serious condition that can occur after pneumonectomy. It is characterized by a mediastinal shift towards the vacated hemithorax, which can potentially lead to respiratory failure. The management of PPS poses a clinical challenge, especially in the context of the limited availability of certain therapeutic devices due to regulatory restrictions in Japan.Case presentationA 36-year-old female with stage IB non-small cell lung cancer underwent left pneumonectomy. Approximately 2 years later, she developed dyspnea. After consulting with our hospital, subsequent imaging revealed an extreme mediastinal shift causing bronchial obstruction. Emergency thoracotomy and subsequent sulfur hexafluoride (SF6) injections were successfully used to manage her condition. Over the course of follow-up, the interval between SF6 injections was extended from 3 to 11 months, indicating an improvement in the intrathoracic condition.ConclusionsThis case illustrates the efficacy of SF6 gas in treating PPS and in reducing the frequency of medical interventions. SF6 gas administration is safe and effective for the treatment of patients with PPS.

Contralateral pneumothorax with postpneumonectomy syndrome: report of 18-year-old case.

We herein report a case of an 18-year-old male with left postpneumonectomy syndrome who underwent a bullectomy for right pneumothorax. The patient underwent a left pneumonectomy at the age of 1year. At the age of 18years, he developed right pneumothorax, and radiological findings revealed apical bullae in the right pleural cavity extending into the left atrophic thoracic cavity beyond the upper mediastinum. The right thoracoscopic bullectomy was successful. Modifications of selective lobar ventilation during surgery and thoracoscope position were described.

Treatment of postpneumonectomy syndrome with silicone breast implant and chimeric latissimus dorsi and serratus anterior muscle flaps

Treatment of postpneumonectomy syndrome with silicone breast implant and chimeric latissimus dorsi and serratus anterior muscle flaps

Postpneumonectomy Syndrome Leading to Severe Hypoxemia Due to a Sudden Ventilation-perfusion Imbalance.

Postpneumonectomy Syndrome Leading to Severe Hypoxemia Due to a Sudden Ventilation-perfusion Imbalance.

Silicone stent placement using a rigid bronchoscope via a tracheostoma in a patient with postpneumonectomy syndrome

BackgroundSilicone stents are options for airway stenosis or obstruction. Generally, silicone stent placement needs rigid bronchoscopy, but manipulation of a rigid bronchoscope has technical difficulties in some cases. The objective of this clinical case report is to highlight silicone stent placement with a rigid bronchoscope successfully achieved by changing the insertion from the mouth to the tracheostoma in a patient with postpneumonectomy syndrome.Case presentationA 47-year-old man underwent right-side pneumonectomy 30 years previously, and he had an intubation tube inserted through a tracheostoma for 29 years to maintain the lumen for bronchial stenosis due to postpneumonectomy syndrome. A granuloma grew at the distal end of intubation tube, and he had labored breathing with stridor. Rigid bronchoscopy for silicone stent placement via the mouth failed because of airway curvature. We sequentially tried rigid bronchoscopy via the tracheostoma as an alternative, and we could easily insert the scope into the left secondary carina and place the silicone stent.ConclusionAlthough strong airway curvature with tracheostomy is an uncommon situation, we succeeded silicone stent placement using a rigid bronchoscope via the tracheostoma. Insertion of a rigid bronchoscope via the tracheostoma instead of via the mouth could be an option.

Reduction of the risk of bronchopleural complications after pneumonectomy due to the use of intraoperative laser treatment of the stump of the main bronchus

Purpose of the study: due to the intraoperative technique of treating the stump of the main bronchus with a high-energy laser LSP-30 during pneumonectomy, to increase the effectiveness of the treatment of patients with destructive widespread pulmonary tuberculosis.Materials and methods. The results of treatment of 112 patients were analyzed. All patients underwent lung removal due to widespread destructive tuberculosis. Patients were divided into main and control groups. The first group, the main one, consisted of 58 patients selected prospectively with a high risk of bronchopleural complications, of which 63.8% (n = 37) of patients had signs of hemoptysis and episodes of pulmonary hemorrhage, which required urgent and sometimes emergency surgical intervention. In 36.2% (n = 21) of patients, limited empyema of the pleural cavity without bronchopleural fistulas was determined radiographically. All patients of the main group after the stage of lung removal before the formation of a stump, the mucosa of the main bronchus was irradiated with a high-energy laser LSP-30 with a wavelength of 930 nm. 54 patients of the control group, selected retrospectively, in whom the course of the fibroticcavernous tuberculosis passed without complications and the HA stump after pneumonectomy was formed without the use of laser irradiation. There were no endoscopic signs of active tuberculous inflammation of the tracheobronchial tree in patients of both groups. A number of patients, in the main group in 5.2% (n = 3) and in the control group in 3.7% (n = 2), showed signs of scarring of the bronchus after tuberculosis. These patients, as part of preoperative preparation, underwent endoscopic biopsy of the main bronchus mucosa in the scar areas, and only after histological confirmation of the absence of active tuberculous inflammation, pneumonectomy was performed.Results. Pronounced post-thoracotomy pain syndrome in 5.2% (n = 3) of patients in the main group and in 9.3% (n = 5) of patients in the control group, for the relief of which narcotic analgesics were used for a long time. Progression of respiratory insufficiency, as a result of accession of nonspecific pneumonia of the only lung in 5.2% (n = 3) of patients of the main group and in 7.4% (n = 4) of patients of the control group, which was resolved by additional resuscitation and avoided mortality. Formation of residual pleural cavity on days 7–21 of the postoperative period in 6.9% (n = 4) of patients in the main group and in 1.8% (n = 1) of patients in the control group in the apex of the hemithorax, which required several sessions of thoracocentesis for the complete elimination of residual pleural cavity. The formation of a pulmonary hernia and the displacement of the mediastinal organs towards fibrothorax, in 5.2% (n = 3) of patients in the main group and in 1.8% (n = 1) in patients of the control group, this complication is the main manifestation of postpneumonectomy syndrome. Progression of tuberculosis in the only lung in 5.2% (n = 3) of patients of the main group and 3.7% (n = 2) of patients in the control group. This complication was revealed radiographically, despite the anti-tuberculosis therapy carried out in the postoperative period in accordance with the sensitivity of Mycobacterium tuberculosis, identified from the surgical material. Intrapleural bleeding in the early postoperative period was detected in 3.7% (n = 2) of patients in the control group, and no such cases were detected in the main group. All cases of intrapleural bleeding in the control group were urgently stopped.Conclusions. The effectiveness of surgical treatment of patients with widespread destructive pulmonary tuberculosis in the volume of pneumonectomy using intraoperative laser treatment of the mucosa of the main bronchus was 98.3%, while in the control group, where the intraoperative technique was not used, it was significantly lower – 87.1% (p < 0.01). A high percentage of cases of histological detection of an inflammatory process on the resection line is a scientifically substantiated confirmation of the need for intraoperative laser treatment of the main bronchus mucosa by the proposed method in patients with widespread destructive tuberculosis during pneumonectomy.

POST-PNEUMONECTOMY SYNDROME IN ADULT PRESENTING WITH RECURRENT SYNCOPE

Post-pneumonectomy syndrome is a rare, late complication of pneumonectomy, caused by a mediastinal shift, rotation and deviation of the remaining lung into the contralateral hemithorax, most commonly resulting in symptomatic central airway compression. Case report: Recurrent syncope following a left pneumonectomy was described in a 63 year-old man, forty years after the initial treatment. Four years physician visit including the family doctor, a neurologist, neurosurgeon, physiatrist, radiologist, psychiatrist and finally a cardiologist made the diagnosis hard to establish and the treatment delayed. The post-pneumonectomy syndrome is a complex constellation of symptoms, following previous lung pneumonectomy, with various presentations mimicking different pathologies. Its diagnosis is often misleading, making the treatment and prognosis hard to predict.  Keywords: post-pneumonectomy syndrome, pneumonectomy, syncope, prosthesis implantation, mediastinal repositioning.&nbsp

Successful treatment of advanced tuberculosis of a single lung with staged correction of post-pneumonectomy syndrome

An observation from practice is given – surgical treatment of a patient with advanced tuberculosis of a single lung and a pronounced lung displacement. Patient A., 47 years old, after 3 months from the left pneumonectomy for fibrocavernous tuberculosis complained of dyspnea at rest, and dysphagia, underwent CT scan, which showed a pronounced displace ment of a single right lung with tuberculoma to the left. At the first stage of the surgery, the overstretched section of a single lung with tuberculoma was resected, the displaced lung was put back and a hernial orifice was strengthened with a mesh implant. At the second stage, the extrapleural thoracoplasty was made with resection of I–IV ribs from the side of pneumonectomy to reduce the volume of the left hemithorax and prevent relapse of mediastinal hernia. As a result, the patient stopped dyspnea and dysphagia, radiographically a single right lung was visualized in the right hemithorax.

Intrathoracic prosthesis in children in preventing post pneumonectomy syndrome: Its role in congenital single lung and post pneumonectomy situations

BackgroundPostpneumopnectomy syndrome (PPS) is an extreme rotation and malposition of mediastinum causing dynamic and symptomatic central airway compression, arisingafter pneumonectomy or more uncommonly, in congenital single lung physiology. Affected patients present with severe respiratory compromise. Intrathoracic prosthesis placement is an evolving technique in children that mitigate the effects of thoracic dead space. Research questionAssessment of clinical recovery and functional benefit in children undergoing placement of intrathoracic prosthesis following pneumonectomy or in congenital single lung situations. Study design and methodsRetrospective chart review of patients at Great Ormond Street Hospital from 2010 to 2020 was performed of all patients who underwent intrathoracic tissue expander placement. We summarize the outcomes of twenty four children, including those with both congenital and postpneumonectomy PPS etiology. Results24 Children who underwent placement of intrathoracic prosthesis for PPS in the study period with median age of 3.5 months and weight of 5 kg. Single lung etiology was congenital in 15 children (6 agenesis, 9 hypoplasia), and postpneumonectomy in 9 children. In seven patients, there was associated long segment tracheal stenosis. Pre operative ECMO was required in 2 patients, and pre operative ventilation was required in 12 patients all of whom had congenital single lung. Intrathoracic prosthesis placement was concurrent with intracardiac repair in 5 patients. There were no operative deaths, but one early postoperative death related to septicaemia. Median follow up was 75 months with 10 patients on continued respiratory support and 3 on nocturnal support with good quality of life. Two children needed reoperations for replacement of prosthesis. ConclusionThe use of tissue expanders is within the armamentarium of most plastic surgeons’ practice. We also therefore advocate for a collaborative team approach involving Plastic and Cardiothoracic Surgery for surgical treatment of these patients. This multidisciplinary strategy has improved management of this rare and debilitating condition of PPS, thereby offering significant improvements in general progress of these sick children having single lung physiology. Evidence is still lacking on functional outcomes in these children and further work is necessary to prove that this is indeed achievable.

Commentary on intrathoracic prosthesis in children in preventing post pneumonectomy syndrome: Its role in congenital single lung and post pneumonectomy situations

This is a Commentary on the manuscript titled "Intrathoracic Prosthesis in Children in Preventing Post Pneumonectomy Syndrome: Its Role in Congenital Single Lung and Post Pneumonectomy Situations" by Quong etal.

A rare complication of left pneumonectomy

Postpneumonectomy syndrome (PPS) is a rare complication of pneumonectomy occurring due to extreme rotation and malposition of mediastinum resulting in dynamic central airway compression between adjacent vascular structures and vertebra. Intrathoracic prosthesis placement is an evolving technique to treat this by alleviating the effects of thoracic dead space. We hereby present a case of post pneumonectomy syndrome which is rare in adults and further rarer following left pneumonectomy as in this case.

Postpneumonectomy syndrome related to the thickness of the fat tissue in the anterior mediastinum: a retrospective observational study.

BackgroundPostpneumonectomy syndrome (PPS) is a life-threatening condition characterized by the extrinsic compression of the mainstem bronchus after pneumonectomy, causing rapidly progressive dyspnea. Information regarding the predictive factors of this condition is limited. Thus, the current study aimed to identify the predictive findings that can help prepare the treatment of PPS in advance.MethodsThe present study is a retrospective observational study. We reviewed the medical records of 12 consecutive patients who underwent pneumonectomy for lung cancer or tuberculosis between 2009 and 2020. The anatomical findings evaluated via computed tomography scan, nutritional status assessed using laboratory data, respiratory function, intraoperative variables between PPS and non-postpneumonectomy-syndrome patients were compared.ResultsThere were two female patients who presented with left PPS (PPS 1 and PPS 2 aged 73 and 55 years, respectively). The median age of 10 non-postpneumonectomy-syndrome patients (n=6, men and n=4 women) was 66 (range, 54–76 years). Four and six patients underwent right and left pneumonectomy, respectively. The fat tissue thickness in the anterior mediastinum was significantly thinner in PPS than in non-postpneumonectomy-syndrome patients. However, the body mass index (BMI) and other nutritional parameters did not differ between PPS and non-postpneumonectomy-syndrome patients. The median vital capacity was higher in PPS than in non-postpneumonectomy-syndrome patients. The decrement of respiratory function and body weight after pneumonectomy did not differ between two groups. The intraoperative variables did not also differ between two groups.ConclusionsThe fat tissue in the anterior mediastinum between the bilateral lungs is an anchor that can help maintain the normal position of the mediastinum after pneumonectomy. Thus, the fat tissue thickness between the bilateral lungs can be a predictive factor for the occurrence of PPS before surgery.

Leadless pacemaker implantation in postpneumonectomy syndrome

About 4.5–20% of patients after heart transplant require pacemaker (PM) implantation. The high infective risk profile and the low probability of pacing dependency make heart-transplanted patients the ideal candidates for a leadless single-chamber PM. We report the first multicenter experience of leadless PM implantation in a series of heart-transplanted patients with a long-term follow-up. Our data confirm the feasibility and acceptable safety of leadless device in this peculiar kind of patients, despite implantation seems to be slightly more challenging with respect to non-transplanted patients. Although more data are required, a leadless single-chamber surveillance PM seems a valuable option for heart-transplanted patients.

Postpneumonectomy syndrome

Postpneumonectomy syndrome

Anesthetic Approach to Postpneumonectomy Syndrome

Anesthetic Approach to Postpneumonectomy Syndrome

Surgical correction of postpneumonectomy syndrome with adjustable saline implants and transoesophageal echocardiography.

Postpneumonectomy syndrome can have a significant clinical impact on a patient. It presents as progressive dyspnoea due to compression of the contralateral bronchus and/or pulmonary veins. Herein, we present a patient who over a 2-year period developed progressive dyspnoea on exertion and eventually also at rest, due to compression of her left mainstem bronchus and her left inferior pulmonary vein. Surgical correction with implantable adjustable saline implants was undertaken to ameliorate her symptoms. Concurrent use of intraoperative transoesophageal echocardiography permitted real-time adjustment of the implants. This allowed objective measurement and demonstration of normalization of pulmonary vein velocity, which resulted in complete symptom resolution.

POSTLOBECTOMY PULMONARY EDEMA: A RARE BUT LETHAL COMPLICATION

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Post-lobectomy pulmonary edema is a fairly rare, but disastrous complication carrying a very high mortality rate. Given that this complication can present in patients with no prior evidence of cardiac disease, without evidence of systemic volume overload and with non-specific findings on early chest imaging, clinicians must have a low-threshold for suspicion as delayed treatment is often fatal. CASE PRESENTATION: A 63 year-old male with type 1 diabetes mellitus, hypertension, chronic kidney disease stage III and right lung adenocarcinoma admitted for a right lower lobectomy. For the first 2 days post-op, patient required non-rebreather mask for mild, intermittent desaturations with chest XR demonstrating small right pleural effusion and small right pneumothorax with atelectasis. On post-operative day 3, developed persistent hypoxia requiring continuous BiPAP and transfer to ICU. Chest x-ray at that time demonstrated a new non-specific left mid-lung opacification and patient was started on antibiotic coverage. Over the following 24 hours, serial chest imaging demonstrated evolution of left pulmonary opacification to involve entire lung consistent with acute lung injury/pulmonary edema. Patient was started on a furosemide infusion and discontinuation of antibiotics followed by transition to scheduled IV furosemide. Patient experienced clinical improvement, was successfully weaned off oxygen and repeat imaging demonstrated significant improvement in bilateral lung fields. DISCUSSION: Surgical resection continues to be the gold-standard for definitive treatment of non-metastatic non-small cell lung cancer and several retrospective studies have described the incidence, morbidity, and mortality of post-procedure pulmonary edema. The incidence ranges from 1-7% after lobectomy with a mortality rate ranging from 50-100%. The etiology is likely multifactorial, including oxidative damage from ischemia-reperfusion, over-zealous intra- and post-operative fluid administration and disrupted lymphatic drainage. The contra-lateral lung is also often exposed to hyperoxia, volutrauma and hyperinflation as ventilation is directed away from the region in which the lobectomy or pneumonectomy is being performed resulting in endothelial damage. Our patient was fortunate to have serial imaging performed which demonstrated the progression of his pulmonary edema allowing for prompt adjustments being made to his therapy. CONCLUSIONS: As patients do not follow a uniform course and pulmonary edema has been documented occurring anywhere from the first 12 hours to as late as 7 days post-op, diagnosis of post-lobectomy pulmonary edema can often be difficult as patient’s may not have any other clinical signs of volume overload. This is complicated by early imaging often demonstrating non-specific changes which may lead clinicians to other conclusions (eg. infection) which may delay proper treatment. Reference #1: Jordan, S., Mitchell, J. a, Quinlan, G. J., Goldstraw, P., & Evans, T. W. (2000). The pathogenesis of lung injury following pulmonary resection. The European Respiratory Journal, 15(4), 790–799. Reference #2: Villeneuve, P. J., & Sundaresan, S. (2006). Complications of Pulmonary Resection: Postpneumonectomy Pulmonary Edema and Postpneumonectomy Syndrome. Thoracic Surgery Clinics. Reference #3: Cook, D., Powell, E., & Gao-Smith, F. (2007). Post-pneumonectomy pulmonary edema. In Yearbook of Intensive Care and Emergency Medicine 2009 (pp. 473–482). DISCLOSURES: No relevant relationships by Erika Faircloth, source=Web Response No relevant relationships by Deep Phachu, source=Web Response

Correction of postpneumonectomy syndrome after bronchopleural fistula

BackgroundPostpneumonectomy syndrome is a rare complication of pneumonectomy characterized by mediastinal shift toward the pneumonectomy cavity. Bronchopleural fistula (BPF) is another infrequent complication causing infection of the pneumonectomy space. The combination of both complications poses a major clinical challenge.Case presentationWe present a case of successful surgical correction of postpneumonectomy syndrome in a patient with previous BPF and associated empyema. Intraoperative gram stain and cultures were used to rule out a persistent infection. Medialization of the mid and lower mediastinum was performed avoiding manipulation of the bronchial stump and its muscle buttress following previous BPF closure. Placement of intrathoracic implants resulted in resolution of symptoms.ConclusionsThis case highlights important clinical considerations for correction of a postpneumonectomy syndrome following BPF. A subclinical infection should be ruled out prior to placement of implants. Partial medialization and symptomatic improvement may be accomplished without disrupting the bronchial stump after healed BPF.

Postpneumonectomy-like syndrome due to bronchial carcinoid: a unique case report

BackgroundPostpneumonectomy-like syndrome is a rare condition resulting from unilateral lung disease with severe lung volume loss leading to excessive mediastinal shift and herniation of the healthy lung into the contralateral hemithorax, mimicking the mediastinal shift observed in postpneumonectomy syndrome after pneumonectomy. We report a unique case of postpneumonectomy-like syndrome caused by an atypical bronchial carcinoid completely occluding the left main bronchus.Case presentationA 25-year-old woman presented with symptoms of chronic exertional dyspnea and productive cough. Imaging studies showed complete left lung atelectasis due to a mass occluding the left main bronchus, as well as extreme mediastinal deviation and substantial herniation of the right lung into the left hemithorax. Bronchoscopic biopsy of the tumor and subsequent left pneumonectomy with concurrent lymph node dissection revealed an atypical carcinoid. Sixteen months after surgery the patient has been asymptomatic with repeat imaging studies showing no change in mediastinal shifting.ConclusionBronchial carcinoids are notorious for causing bronchial obstruction. The present case represents an extreme complication of centrally located bronchial carcinoid, resulting in postpneumonectomy-like syndrome with severe mediastinal shift and herniation of the healthy lung into the diseased hemithorax.

Medical image of the week: post pneumonectomy syndrome

Medical image of the week: post pneumonectomy syndrome