Pneumothorax after pneumonectomy: surgery with successful double lobe ventilation

Left lung agenesis discovered by a spontaneous pneumothorax in a 20-year-old girl

Lung agenesis is a rare condition which prognosis widely depends on associated malformations. Clinical presentation is so variable and diagnosis is often made in childhood. Here, we present a case of a 20-year-old girl who was admitted because of a spontaneous pneumothorax. Explorations concluded at a left lung agenesis, a hyperinflated right lung crossing the midline with a corresponding pneumothorax. There was no malformation else. This congenital condition and treatment for this rare presentation are discussed in detail.

[Lung cancer surgery in a single-lung]

INTRODUCTION

The diagnosis of a second lung cancer in a patient with a previous medical history of lung cancer is no longer a rarity. Also, it is possible to observe a new location in a patient who underwent pneumonectomy in the past. Surgery remains the best treatment. Our objective was to overview this subject.

PATIENTS AND METHODS

Among 5611 patients operated in our institution, 186 (3.3%) had metachronous cancer and 17 had previous pneumonectomy (0.7% of pneumonectomies and 0.2% of NSCLC treated in our department). The procedure was diagnostic and therapeutic in 88% of cases (n=15).

RESULTS

There were 16 males and 1 female, mean age was 62.5-years. All were smokers (11 were former smokers) and 6 had other medical history. Mean FEV was 52% (range 35-95%). Types of resection were 2 lobectomies, 4 segmentectomies, and 11 wedge resections. There were no postoperative deaths, but two complications. Histological subtype of the first and second cancer was the same in 11 patients. All patients were pN0 after second surgery. The long-term survival (median 33 months) was 35.3% at 5-years and 14.1% at 10-years. Two patients treated with pneumonectomy for their first cancer were pN2. Patients who underwent upper right lobectomy for treatment of their second cancer survived longer than 5-years.

CONCLUSION

Surgical resection for lung cancer on single-lung is associated with acceptable morbidity and mortality. Prolonged survival can be achieved in selected patients.

Four cases of contralateral pneumothorax after pneumonectomy

Contralateral pneumothorax after pneumonectomy (CPAP) is a rare but potentially fatal condition. Therefore, when treating CPAP prevention of recurrence is very important. Despite a number of case reports about CPAP, its management is still controversial. We describe 4 cases of CPAP that were treated successfully by bullectomy and coverage with absorbable polyglactin mesh.

Contralateral pneumothorax in bullous lung after pneumonectomy: report of two cases

Contralateral pneumothorax after pneumonectomy is potentially fatal. We experienced two cases of right pneumothorax after left pneumonectomy in which the patients had multiple bullae in the right lung. Case 1 involved a 49-year-old man with non-small-cell lung cancer (NSCLC) who underwent left pneumonectomy after induction chemoradiotherapy. Eleven months after surgery, he had pneumothorax and was treated with chest tube drainage and pleurodesis. He was discharged but died of recurrent pneumothorax 1 month later. Case 2 involved a 57-year-old man with NSCLC who had left pneumonectomy. Five months after surgery, he had pneumothorax and was treated with chest tube drainage. Because of prolonged air leak, ligation of the ruptured bulla was performed with a percutaneous cardiopulmonary support system on standby. No pneumothorax recurrence occurred for 2 years. Although management of pneumothorax after pneumonectomy is challenging, surgical intervention may be useful and necessary especially when there is high risk of recurrent pneumothorax.

Spontaneous pneumothorax after traumatic pneumonectomy: a role for talc pleurodesis in secondary prevention?

We report a case of spontaneous contralateral pneumothorax 2 months after a pneumonectomy, with the initial placement of an intercostal chest drain on the side of the pneumothorax. Due to the high risk of a subsequent life-threatening pneumothorax, pleurodesis became an important consideration. Surgical pleurodesis can be complicated by the risks of single lung ventilation; therefore, talc pleurodesis was performed by using the intercostal drain once the lung had fully expanded. The patient remains free of recurrence 14 months after the pneumonectomy. Our case suggests that talc may be an effective alternative method of secondary prevention of a pneumothorax after a pneumonectomy.