Unilateral lung volume reduction in preparation for contralateral pneumonectomy

A case of staged trans-sternal unilateral lung volume reduction (LVR) on the right followed by contralateral pneumonectomy for a locally advanced left lung malignancy is presented. The predicted symptomatic and functional benefit offered by LVR was felt to be necessary before the removal of the left lung. The patient, a 50-year-old male, with a history of chronic air flow limitation secondary to bullous emphysema, underwent a left pneumonectomy six weeks following a right LVR procedure for poor pulmonary function secondary to generalized emphysema. On admission, forced expiratory volume in 1 s (FEV1) was 1.37 L, 47% of predicted with an FEV1/forced vital capacity of 56%. Five weeks after the unilateral LVR, the patient's FEV1 was 1.85 L, and one year postdischarge from hospital, FEV1 was 0.9 L. One year after discharge, the patient did not require oxygen support, and was active and free of malignant disease.