Post-Pneumonectomy Syndrome: Surgical Correction Using Silastic Implants

doi:10.1378/chest.75.1.78

Chest

Volume 75, Issue 1, January 1979, Pages 78-80

https://doi.org/10.1378/chest.75.1.78 Get rights and content

A post-right pneumonectomy syndrome is described which manifests symptoms of exertional dyspnea and inspiratory stridor on rapid inspiration. These symptoms were associated with marked rightward and posterior deviation of the trachea, over-distention of the left lung with its herniation into the right side of the chest and kinking of the left lower lobe bronchus. At the time of surgery, the tracheal deviation, lung herniation and the kink in the left lower lobe bronchus were immediately corrected by releasing the adhesions between the malpositioned structures and the right chest wall. To maintain the corrected positions, Silastic implants totalling a volume of 990 ml were placed into the space created in the right chest Following surgery, exertional dyspnea was present with only extraordinary activity, and inspiratory stridor was eliminated. The patient remains asymptomatic three years following surgical correction, and is able to carry on a normal and productive life. We conclude that a syndrome associated with marked exertional dyspnea and inspiratory stridor might develop in situations of marked tracheal shift and overdistention of the remaining lung following right pneumonectomy.

Section snippets

Case Report

A 23-year-old Israeli jet pilot's plane was shot down over Syria in October, 1973. As he parachuted to earth, he was shot several times. One bullet pierced his right chest anteriorly and exited through the back. In Damascus, right pneumonectomy was performed. The hilar blood vessels and the remaining stumps of the bronchus intermedius and right upper lobe were sealed with staples. Medical reports are not available to ascertain postoperative events, blood volume replacement, and fluid intake. It

Results

The positions of the heart, lung and major airways have remained stable since the last operation (Fig 1b). The patient no longer has a cough or stridulous breathing. He experiences exertional dyspnea only with extraordinary activity such as walking up steep grades at a relatively rapid pace. Pulmonary function studies (Table 1) performed six months following the last operation showed improvement in lung volumes and forced expiratory flow rates.

The patient's exercise performance was re-evaluated

Discussion

The abnormal physiologic findings and anatomic distortions noted on the roentgenographic and bronchoscopic examinations undoubtedly resulted from the right pneumonectomy. The mediastinum, heart and left lung were shifted into the right thoracic space, and the trachea deviated markedly to the right and posteriorly before it curved anteriorly toward the main carina. The stridor, which was most noticeable during inspiration, was probably created by the increase in air turbulence in the trachea

ACKNOWLEDGMENT

We thank Drs. Gordon Gamsu and Jay A. Nadel, University of California in San Francisco, for their help in performing specialized radiologic studies for us preoperatively. We are also especially grateful to Drs. Oded Bar-Or and Omri Inbar from Wingate College, Israel, for their help in performing the pre- and postoperative exercise tests.

References (5)

S Kristersson et al.
Prediction of pulmonary function loss due to pneumonectomy using ¹³³Xe-radiospirometry
Chest
(1972)
MK Ali et al.
Regional pulmonary function before and after pneumonectomy using ¹³³xenon
Chest
(1975)

There are more references available in the full text version of this article.

Cited by (65)

Video-assisted thoracoscopic surgery for prevention of postpneumonectomy syndrome: A case report
2023, International Journal of Surgery Case Reports
Postpneumonectomy syndrome is a pathological condition consisting in a persistent violation of the function of external respiration caused by the inflection of the trachea and/or the main bronchus and manifested by respiratory insufficiency.
The article describes a method of video-assisted thoracoscopic surgery for intraoperative prevention of the development of postpneumonectomy syndrome by installing a mesh implant in a patient with central cancer of the right lung.
The range of alternatives that have been put forth for the treatment and prevention of the emergence of postpneumonectomy syndrome, on the one hand, demonstrates the relevance of the issue and, on the other, demonstrates the inadequate outcomes of the employed techniques.
As a result of a mesh implant that is rigidly linked to the ribs, the preventative strategy we describe reliably prevents mediastinal displacement and doesn't necessitate repeated surgical intervention.
Inflammatory State After Intrathoracic Breast Implant Placement for Postpneumonectomy Syndrome
2020, Annals of Thoracic Surgery
We describe a case of a 16-year-old patient who underwent right pneumonectomy for pulmonary vein atresia and developed postpneumonectomy syndrome. She had an 800-cm³ saline-filled silicone tissue expander placed in the right hemithorax with resolution of her postpneumonectomy syndrome. However, 2 years later, she developed fevers, night sweats, and arthralgias. Her medical workup was negative for vasculitis, inflammatory bowel disease, and infectious etiologies. She underwent tissue expander removal, resulting in resolution of her symptoms. This report describes a case of an inflammatory state created by a tissue expander placed for postpneumonectomy syndrome.
Correction of a postpneumonectomy syndrome with congenital pectus excavatum using Ravitch's procedure and silicone breast implants. Report of a case
2020, International Journal of Surgery Case Reports
Mediastinal repositioning and the use of allogenic implants to obliterate the postpneumonectomy space is the main principle of postpneumonectomy syndrome (PPS) correction. We present a rare case with a PPS in combination with a congenital pectus excavatum. As a pectus excavatus deformity reduces retrosternal space, simple repositioning of the heart is impossible unless combined with a sternum elevation.
Two years after left sided pneumonectomy a 30 year old female was admitted with progressive exertional dyspnea and stridor and not able to do her basic activities. Chest CT-scan and bronchoscopy revealed severe right main bronchus stenosis, compression of hilar vessels and the presence of a pectus excavatum deformity. A single stage operative correction was performed with sternum repositioning by a Ravitch’s procedure, pericardial fixation to the right sternal edge and obliteration of the left thoracic cavity with two silicone breast implants. All complaints disappeared within 48 h.
To the best of our knowledge, this is the first report about successful treatment of PPS aggravated by a preexisting pectus excavatum in an adult patient. The durability and migration of the silicone implants and the volume reduction of the pericardial sac during fixation to the sternum continues to remain a concern.
Single stage correction of PPS and pectus deformity is feasible and seems to be the appropriate treatment for both pathologies.
Correction of postpneumonectomy syndrome with tridimensional carbon fiber–printed implant
2018, Journal of Thoracic and Cardiovascular Surgery
Postpneumonectomy syndrome in a newborn after esophageal atresia repair
2015, International Journal of Surgery Case Reports
Citation Excerpt :
When such a clinical picture occurs in patients with group 1 CBPFM, the term pseudo-PPS seems more appropriate as they do not undergo lung resection surgery. Classically, treatment of CBPFM is to resect the aberrant lung tissue with lobectomy or pneumonectomy and mediastinal repositioning using rigid prostheses (e.g. breast prostheses) or tissue expanders in the empty hemithorax [8,9]. Reimplantation of the anomalous bronchus is the ideal management but was attempted in only one patient with CBPFM associated with OA, which was successful [10].
Postpneumonectomy syndrome (PPS) is an ominous complication, caused by mediastinal shift following massive lung resection.
A neonate with oesophageal atresia and tracheo-oesophageal fistula developed acute respiratory distress shortly after surgery, despite mechanical ventilation. The patient was found to have an associated oesophageal right lung that collapsed after oesophageal atresia repair and a left pulmonary artery sling causing left main bronchus stenosis mimicking a postpneumonectomy syndrome.
We will describe the diagnostic work-up and the therapeutic measures used both in the acute phase and as definitive treatment in this challenging case.
Neonatologists and paediatric surgeons should be aware of this rare association that may cause acute life threatening and worsening of patient’s clinical status. Prompt realignment of the mediastinum in the normal position is critical to obtain rapid improvement of the patient’s clinical conditions.
Intrathoracic tissue expanders for postpneumonectomy syndrome
2014, Journal of Plastic, Reconstructive and Aesthetic Surgery

View all citing articles on Scopus

View full text

Chest

Selected ReportsPost-Pneumonectomy Syndrome: Surgical Correction Using Silastic Implants

Section snippets

Case Report

Results

Discussion

ACKNOWLEDGMENT

Chest

Chest

Selected Reports
Post-Pneumonectomy Syndrome: Surgical Correction Using Silastic Implants