A 68-Year-Old Man With Intractable Dyspnea and Wheezing 45 Years After a Pneumonectomy

Right pneumonectomy syndrome: a late life-threatening complication of pneumonectomy

BACKGROUND

Right pneumonectomy syndrome, a rare complication of pneumonectomy, is secondary to a shift of the mediastinum and remaining lung toward the pneumonectomy side, leading to extrinsic airway compression and stretching.

CASE

A 6-year-old boy started with initial symptoms of dyspnea on exertion, wheezing, and recurrent pneumonia 6 months after his right pneumonectomy. He received treatment with bronchodilators and antibiotics during outpatient clinic visits. Two months later, he developed increased wheezing and productive cough. A pulmonary function test showed severe reduction in expiratory volumes. He had a cardiopulmonary arrest while a surgical intervention was being planned. Chest roentgenogram showed shift of the heart and mediastinal structures into the right hemithorax with left lung hyperexpansion and no fluid in the right hemithorax. A computed tomogram of the chest revealed marked narrowing of the proximal left mainstem bronchus. He underwent thoracotomy, and a silicone prosthesis was inserted into the right hemithorax, resulting in restoration of the structures to the midline. The child presented severe neurological sequelae.

CONCLUSIONS

Postpneumonectomy syndrome is a rare but life-threatening complication after pneumonectomy. Because it may mimic other conditions and given the consequences can be devastating, early recognition and intervention are required to ensure a favorable outcome.

Right pneumonectomy syndrome presenting as a cardiac arrest in a two-year-old

INTRODUCTION

Pneumonectomy syndrome is a rare complication after pneumonectomy with variable onset and presentation. It is characterized by extrinsic airway compression secondary to mediastinal shift. As far as we are aware, we are reporting the first pediatric case of pneumonectomy syndrome presenting as a cardio-pulmonary arrest.

PATIENT AND INTERVENTION

A two-year-old boy presented with a cardiac arrest 8 months after his pneumonectomy. He failed extubation twice. A flexible bronchoscopy was then performed which revealed external compression of the left mainstem bronchus. He underwent surgical correction with a prosthetic, thoracic implant.

RESULT

The patient's trachea was subsequently extubated to room air on postoperative day 1. He remains clinically stable at 6 month follow-up.

CONCLUSION

Postpneumonectomy syndrome is a rare but serious complication after pneumonectomy. If the airway compression occurs in conjunction with compromised vena caval return, cardio-pulmonary arrest can occur. Therefore, timely diagnosis and early intervention is required.