Syndrome after pneumonectomy

The syndrome after pneumonectomy is an unusual complication of pneumonectomy resulting from excessive displacement of the mediastinal structures toward the empty pleural space. In infants, children, and infrequently in young or middle- aged adults, excessive mediastinal shift after pneumonectomy occurs gradually. The resultant compression of the remaining contralateral bronchus leads to severe respiratory compromise. Development of the syndrome is most common after right pneumonectomy, is infrequently seen after left pneumonectomy in patients with a right-sided aortic arch, and is observed rarely after left pneumonectomy in patients with a normal position of the aortic arch in the left hemithorax. The typical clinical presentation is that of dyspnea, which occurs months or years after surgery, and the diagnosis is confirmed by documenting, on computed tomographic scan or by bronchoscopy, significant tracheobronchial obstruction. The problem can be corrected by restoration of the normal relation of the mediastinal structures, which is best achieved by inserting a tissue expander in the empty chest cavity. Endoluminal stenting seems to offer the most efficient treatment of associated tracheobronchomalacia.