Postpneumonectomy Syndrome Symptoms, Causes, Diagnosis, Treatment

Postpneumonetomy syndrome is a condition in which, after pneumonectomy, the mediastinum gets significantly rotated and displaced. As a result, there are signs of regional airways tension and dynamic airway obstruction. After a pneumonectomy, the space is filled by the heart and the mediastinum. Due to this, the airway becomes confined between both the pulmonary artery and the aorta or spinal column, and the residual lung herniates and enlarges. Previously, it was believed that right pneumonectomy patients were the only ones who experienced postpneumonectomy syndrome. On the other hand, there have been numerous cases of this syndrome occurring in patients who underwent left pneumonectomy after having a left-sided aortic arch.

Postpneumonectomy Syndrome Symptoms

Dyspnea, stridor, and trouble clearing secretions are common signs of airway blockage in postpneumonectomy syndrome, and some patients also experience bouts of acute breathing difficulties. Certain patients appear with a severe case of scoliosis. Rarely, esophageal compression by the heart, aorta, or inferior vena cava can cause individuals to develop progressive dysphagia.

Postpneumonectomy Syndrome Causes

This syndrome is a problem that can happen after a pneumonectomy. It is marked by blocked airways, high blood pressure in the lungs, and pressure on the esophagus, which is caused by the mediastinum moving towards the pneumonectomy cavity.

After a pneumonectomy, the mediastinum rotates and shifts dramatically, leading to the rare but potentially fatal condition known as postpneumonectomy syndrome. Distal trachea and major bronchus compression cause dynamic airway obstruction.

Postpneumonectomy Syndrome Diagnosis

Postpneumonectomy syndrome is diagnosed when vascular structures press on the tracheobronchial tree. Pneumonectomy-induced respiratory insufficiency warrants more investigation. Postpneumonectomy syndrome is diagnosed by tracheobronchial compression. On a chest X-ray, the postpneumonectomy syndrome can be seen when the heart and mediastinum move deep into a hemithorax, the postpneumonectomy space is filled in, and the remaining lung is stretched out too much. 

The point of airway blockage can be located using computed tomography (CT), for example, at the junction of the coronary artery and the abdominal artery, or the level of a vertebral body.  Dynamic airway blockages are mostly shown using expiratory CT. PFTs (pulmonary function tests) also demonstrate the typical pneumonectomy alterations. After pneumonectomy, the FVC may be larger than predicted due to overexpansion of the residual lung.

Postpneumonectomy Syndrome Treatment

Postpneumonectomy syndrome should be treated early to avoid long-term complications and acute respiratory discomfort. Postpneumonectomy syndrome is treated surgically by repositioning the mediastinum and filling the postpneumonectomy space. This is done to fix the placement of the herniated lung and return the compressed air passages to their normal position.

Due to the rarity of PPS, surgical treatment recommendations based on controlled trials cannot be offered. For high-risk patients, tracheobronchial stenting can be a possibility. Although most of the patients documented in the literature received this technique, it is clear that repositioning the mediastinum and fixing it with the implantation of a thoracic prosthesis is the preferred course of treatment. In conclusion, doctors advise treating symptomatic individuals by repositioning the mediastinum with an intrathoracic prosthesis.