A case of so-called postpneumonectomy syndrome treated by mediastinal repositioning

Abstract

We present a rare case of so-called postpneumonectomy syndrome caused by displacement and rotation of the mediastinal structures into the dead space after bilobectomy of the right lung. A 73-year-old woman underwent right, middle and lower lobectomy because of pulmonary tuberculosis accompanied by aspergillosis in 1993 at 69 years old. Approximately four years later, she complained of exertional dyspnea and suffered near respiratory arrest. Chest X-ray, CT and bronchoscopic examination demonstrated marked narrowing of the left main bronchus. Pulmonary function studies evidenced upper airway obstruction. Corrective surgical repositioning was applied. After the thoracic space was reopened, lysis of adhesion, mobilization of the mediastial structures and anchoring pericardium to the anterior parasternal chest wall were performed. An expandable prosthesis was inserted into the space and filled with saline. The anteroposterior compression of the left main bronchus was relieved and the respiratory function was improved. Although the prosthesis was removed owing to infection, the improved status of respiration has been maintained for three years. Combination of mediastinal repositioning and plombage with an expandable prosthesis was useful in the management of postpneumonectomy syndrome.