Ann Thorac Surg 2010;89:312. doi:10.1016/j.athoracsur.2009.02.086
© 2010 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Post-Pneumonectomy Cavity: Is There Still a Cavity?
Dionisios Stavroulias, MD*,*,
Luca Ampollini, MD*,
Paolo Carbognani, MD, PhD,
Michele Rusca, MD
Unit of Thoracic Surgery, Department of Surgical Science, University Hospital of Parma, Parma, Italy
* Address correspondence to Dr Stavroulias, Chirurgia Toracica, Azienda Ospedaliero-Universitaria di Parma, Viale Gramsci 14, Parma, 43100, Italy (Email: fodio79{at}yahoo.it).
A 60-year-old man with a 40-pack/year smoking history was admitted for recurrent hemoptysis. He had no history of previous disorders. A physical examination and routine laboratory tests showed normal results. A mass lesion in the right hilum was observed on chest roentgenogram. A chest computed tomographic scan revealed a 6-cm tumor mass infiltrating the inferior and median lobe adjacent to the inferior pulmonary vein at its origin and pulmonary artery. Fiberoptic bronchoscopy disclosed an obstruction of the intermediate bronchus just below the origin of the superior lobar bronchus. Pathology results of the biopsy showed squamous cell carcinoma. The patient underwent a posterolateral right thoracotomy; a centrally located tumor invading the pericardium was observed on exploration. An intrapericardial right pneumonectomy was performed; an intercostal muscle flap was placed on the bronchial stump. The postoperative course was uneventful, and the patient was discharged on day 9. The histological examination revealed R0 resection with pathologic stage T3N0M0 squamous cell carcinoma.
During follow-up the patient had physical examinations every 3 months for the first 2 years and then every 6 months thereafter through year 5; the follow-ups are planned to continue annually afterward [1]. A chest roentgenogram is always performed at the follow-up examination. A gradual mediastinal shift and left pulmonary hernia was progressively noted on his chest roentgenogram 2 years after the operation (Fig 1 A). The chest roentgenogram is shown in Figure 1B from the 3-year postoperative follow-up. After a 5-year postoperative period, a chest computed tomographic scan was performed; a complete hernia of the left lung into the right side with displacement of the mediastinal structures was visible (Fig 2). The patient was well and disease-free; no respiratory symptoms or dyspnea were present.
Mediastinal shift is common after pneumonectomy and herniation of the remaining lung into the opposite hemithorax, has been reported [2, 3]. Tracheobronchial malacia (due to prolonged pressure secondary to lung hernia) has been described after right pneumonectomy in children [4]. In cases of severe symptoms secondary to postpneumonectomy syndrome, different treatment options have been used, such as bronchial stent positioning and intrapleural prostheses insertion [3, 5].
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* The first two authors contributed equally to this work. 
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References
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