Postpneumonectomy syndrome

Maria Lucia L. Madariaga, Douglas J. Mathisen


Postpneumonectomy syndrome refers to a constellation of symptoms from airway compression due to mediastinal shifting after pneumonectomy. The heart and mediastinum rotate into the postpneumonectomy space, resulting in two processes: (I) herniation and hyper-expansion of the remaining lung and (II) compression of the airway (trachea, bronchus or lobar orifice) between the pulmonary artery and aorta or vertebral column (Figure 1). Postpneumonectomy syndrome was previously thought a phenomenon limited to patients with left-sided aortic arches who underwent right pneumonectomy (or vice versa), but there have been several case reports of postpneumonectomy syndrome occurring in patients with left-sided aortic arch and left pneumonectomy (1-4). In these cases, the bronchus intermedius was elongated and compressed between the right main pulmonary artery and the thoracic spine.