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Updated: May 21, 2025
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Postpneumonectomy space infection eight years after mediastinal repositioning procedure
Edward Staniforth1, Rhona Taberham2, Lucy Cogswell3
1Medical School, University of Oxford, Oxford, UK.
Abstract:
Postpneumonectomy syndrome is a rare complication following pneumonectomy. Repositioning of the mediastinum via insertion of prosthetic implants into the postpneumonectomy space can provide symptomatic relief. We present a case of a man in his early 70s presenting with empyema necessitans 8 years after the implantation of silicon-saline prostheses for the management of postpneumonectomy syndrome. Excision of the chest wall sinus, re-do right thoracotomy and removal of the infected silicon-saline prostheses and postprocedural intrapleural irrigation led to resolution. There was no evidence of mediastinitis. At the 1-year follow-up, the patient remained well, with a centralised mediastinum without further evidence of infection of the postpneumonectomy space. This is to our knowledge the first reported case of chronic infection of a repositioned mediastinum in the context of postpneumonectomy syndrome.
Insights
This case study details a rare chronic infection of a repositioned mediastinum in a patient with postpneumonectomy syndrome. Surgical removal of infected prostheses successfully resolved the empyema necessitans.
Area of Science:
- Thoracic Surgery
- Surgical Complications
- Infectious Diseases
Background:
- Postpneumonectomy syndrome can necessitate mediastinal repositioning using prosthetic implants.
- Chronic infection of these implants is a rare but serious complication.
Purpose of the Study:
- To report the first known case of chronic infection of a repositioned mediastinum in postpneumonectomy syndrome.
- To describe the successful management of empyema necessitans secondary to infected prostheses.
Main Methods:
- Presentation of a case involving a patient with empyema necessitans 8 years post-prosthetic implantation for postpneumonectomy syndrome.
- Surgical intervention included chest wall sinus excision, re-do thoracotomy, infected prosthesis removal, and intrapleural irrigation.
Main Results:
- Successful resolution of empyema necessitans and infection.
- Patient remained clinically well at 1-year follow-up with a centralized mediastinum and no recurrence of infection.
- No evidence of mediastinitis was found.
Conclusions:
- Chronic infection of repositioned mediastinal prostheses can occur in postpneumonectomy syndrome.
- Aggressive surgical management, including prosthesis removal and irrigation, can effectively treat this complication.
- This case highlights the importance of vigilance for late-onset infections in patients with prosthetic materials in the postpneumonectomy space.
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