Right-pneumonectomy syndrome: radiologic findings and CT correlation

The clinical history and radiographic and bronchoscopic findings were reviewed retrospectively in five patients with right-pneumonectomy syndrome, a rare, delayed complication of pneumonectomy of the right lung. Four patients had undergone pneumonectomy in childhood or adolescence. Presenting symptoms of dyspnea and recurrent pulmonary infections in the left lung were associated with radiographic evidence of marked rightward and posterior deviation of the mediastinum, counterclockwise rotation of the heart and great vessels, and herniation of the left lung into the right, anterior side of the chest. Computed tomography, performed in four patients, best demonstrated resultant compression of the distal trachea and left main bronchus between the aorta and pulmonary artery. Malacia of the major airways (n = 4 cases) and mediastinal shift was visualized only with fluoroscopy and was confirmed by bronchoscopy. Because of the morbidity and mortality associated with dyspnea and recurrent pulmonary infections, proper radiologic evaluation is crucial, and surgical intervention is often necessary.