ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Dale K. Mueller
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mueller, D. K.
Right arrow Articles by Foiles, S. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Mueller, D. K.
Right arrow Articles by Foiles, S. R.
Related Collections
Right arrow Lung - cancer

Ann Thorac Surg 2007;84:1401
© 2007 The Society of Thoracic Surgeons

Images in Cardiothoracic Surgery

Right Mainstem Bronchial Kink After Right Upper Lobectomy

Dale K. Mueller, MDa,b,*, Shannon R. Foiles, MSN, APNb

a HeartCare Midwest, Peoria, Illinois
b OSF Saint Francis Medical Center, Thoracic Center of Excellence, Peoria, Illinois

* Address correspondence to Dr Mueller, HeartCare Midwest, 5405 North Knoxville Ave, Peoria, IL 61614 (Email: mue{at}heartcaremw.com).

A 55-year-old man initially presented with pneumonia that resolved with antibiotics and a persistent right upper lobe mass. Further evaluation revealed a stage I lung cancer. The patient underwent a right upper lobectomy, which included intrapleural pneumolysis for pleural adhesions and a standard thoracic lymphadenectomy. In addition, the right middle lobe was plicated to the lower lobe to avoid middle lobe torsion. Normal anatomy was identified at the thoracotomy with a complete fissure. No additional procedures were done at the time of the thoracotomy, such as a pleural flap for bronchial stump coverage.

Two months later the patient presented with increasing dyspnea. Bronchoscopy demonstrated a superiorly deviated bronchus approximately 180 degrees from the left mainstem bronchus. The only method to successfully interrogate the bronchus was to retroflex the bronchoscope 180 degrees while in the left mainstem bronchus, and withdraw into the right mainstem bronchus.

Both standard and three-dimensional computed tomography confirmed an exaggerated superiorly kinked right mainstem bronchus approximately 180 degrees from the left mainstem bronchus (Figs 1–3). Go Go Consideration was given to stenting the kink or reoperation; however the patient declined.


Figure 1
View larger version (183K):
[in this window]
[in a new window]

  		Fig 1.
 

Figure 2
View larger version (67K):
[in this window]
[in a new window]

  		Fig 2.
 

Figure 3
View larger version (66K):
[in this window]
[in a new window]

  		Fig 3.
 
One month after representation, the patient’s dyspnea markedly improved. The only known contributing factor for spontaneous improvement was the patient’s participation in an outpatient pulmonary rehabilitation program. Unfortunately no repeat computed tomography or bronchoscopic report is available due to the patient’s reluctance to undergo further diagnostics.

To the author’s knowledge, only two patients have been reported with this clinical scenario. Their mainstem bronchial kinks with exaggerated upward displacement were successfully treated with bronchial stenting [1]. However, until now, no computed tomography image of this entity has been published.


   References
Top
 References
 

  1. Van Leuven M, Clayman J, Snow N. Bronchial obstruction after upper lobectomy: kinked bronchus relieved by stenting Ann Thorac Surg 1999;68235–5.



This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
K. Ueda, T. Tanaka, M. Hayashi, N. Tanaka, T.-S. Li, and K. Hamano
Clinical Ramifications of Bronchial Kink After Upper Lobectomy
Ann. Thorac. Surg., January 1, 2012; 93(1): 259 - 265.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
W. J. Scott
Invited Commentary
Ann. Thorac. Surg., January 1, 2012; 93(1): 265 - 265.
[Full Text] [PDF]

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Dale K. Mueller
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mueller, D. K.
Right arrow Articles by Foiles, S. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Mueller, D. K.
Right arrow Articles by Foiles, S. R.
Related Collections
Right arrow Lung - cancer

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS