Surgical treatment for postpneumonectomy syndrome

Abstract

Postpneumonectomy syndrome (PPS) is a rare complication after pneumonectomy characterised by severe mediastinal shift leading to airway compression and respiratory distress. We present a case of a woman in her mid-40s who developed PPS following a right pneumonectomy for bronchial mucoepidermoid carcinoma. Surgical treatment of PPS had not previously been performed in Denmark by Danish surgeons, which is why we consulted with a British surgeon. The surgery was performed in Denmark.The procedure resulted in immediate respiratory improvement, and the patient was discharged 22 days postoperatively. Follow-up demonstrated sustained airway patency and no signs of cancer recurrence. This case highlights the feasibility and effectiveness of surgical management of PPS in centres with limited prior experience and supports mediastinal repositioning with prosthetic implants as a viable treatment option in severe cases.

Keywords: Cardiothoracic surgery; Otolaryngology / ENT; Surgical oncology.

Figure 1. CTscan preoperative and postoperative of thorax showing shift of mediastinum and compression of trachea (1) and left main bronchus (2) and two prostheses in the right hemithorax and repositioning of the mediastinum.

Figure 2. Chest X-ray preoperative in the ICU (left) and 2 days postoperative (right).

Figure 3. Intraoperative findings after right posterolateral thoracotomy.

Figure 4. Bronchoscopy on the 20th postoperative day showing left main bronchus with less compression 1–right main bronchus closed 2–left main bronchus.

Figure 5. Status after 11 months.