A patient undergoing a pneumonectomy may develop a postoperative syndrome caused by displacement of the remaining thoracic contents.
Patient selection: pneumonectomy (removal of an entire lobe)
Mechanism: extreme rotation and shift of mediastinal structures towards the vacated hemithorax with central airway compression by the pulmonary artery against the vertebral column or the aorta.
Clinical features:
(1) progressive and incapacitating dyspnea
(2) cough
(3) stridor or wheezing
(4) recurrent pneumonia
(5) gastroesophageal reflux
(6) hemoptysis
(7) chest pain
The diagnosis is often suspected based on the shift of mediastinal structures seen on imaging studies.
The diagnosis is supported by:
(1) exclusion of alternative diagnoses
(2) relief of symptoms by repositioning thoracic structures (which may require placement of saline-filled prostheses in the evacuated hemithorax
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