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. 2015:10:142-5.
doi: 10.1016/j.ijscr.2015.03.047. Epub 2015 Mar 28.

Postpneumonectomy syndrome in a newborn after esophageal atresia repair

Chiara Iacusso  1 , Pietro Bagolan  1 , Sergio Bottero  2 , Andrea Conforti  1 , Francesco Morini  3
Affiliations

Postpneumonectomy syndrome in a newborn after esophageal atresia repair

Chiara Iacusso et al. Int J Surg Case Rep. 2015.

Abstract

Introduction: Postpneumonectomy syndrome (PPS) is an ominous complication, caused by mediastinal shift following massive lung resection.

Presentation of the case: 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.

Discussion: 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.

Conclusions: 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.

Keywords: Communicating bronchopulmonary foregut malformations; Iatrogenic hydrothorax; Oesophageal atresia; Oesophageal lung; Postpneumonectomy syndrome; Pseudo-postpneumonectomy syndrome; Tissue expander.

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Figures

Fig. 1
Fig. 1
(a) Chest X-rays on admission with nasogastric tube folding in the upper pouch and distended stomach, suggesting an oesophageal atresia with distal tracheo-oesophageal fistula. Note, the right lung is inflated. (b) Post-operative chest X-rays. The right lung is collapsed and the mediastinum is markedly shifted towards the right hemithorax. (c) Oesophagogram with the patient lying on the right side. The right main bronchus (arrow) originates from the right side of the oesophagus, caudal to the anastomosis.
Fig. 2
Fig. 2
(a) Artist rendition of the patient’s preoperative anatomy (posterior view). Oesophageal atresia with tracheo-oesophageal fistula. The right main bronchus originates from the lower oesophagus. The left pulmonary artery (arrow) sling originates from the right pulmonary artery (arrow heads), and courses posterolateral to the left main bronchus and reaches the left hylum, thereby causing left main bronchus stenosis together with the aortic arch (*). (b) A 12 CH foley catheter was inserted in the right hemithorax. (c) An iatrogenic hydrothorax was progressively induced with normal saline and contrast medium. (d) Note, the mediastinum gradually regaining its normal position at the end of the procedure.
See this image and copyright information in PMC

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