Pulmonary hyperinflation following Nd-YAG laser resection of an obstructing mainstem tumor

Nd-YAG laser resection of a completely obstructing right mainstem tumor in a 36-year-old man was complicated by right lung hyperinflation and left lung collapse and accompanying ventilatory failure. This was attributed to obstruction of the right mainstem bronchus during exhalation, but not inhalation, in a patent but irregularly shaped bronchus postresection. Intubation, positive pressure breathing, bronchodilator therapy, and laser excision of residual right mainstem tumor resolved the ventilatory failure.