Postpneumonectomy syndrome with an ipsilateral aortic arch after left pneumonectomy.
BACKGROUND
Previous reports have described bronchial obstruction after left pneumonectomy (so-called post-pneumonectomy syndrome) in the presence of a right aortic arch with the bronchus being compressed between the ascending aorta and thoracic spine. This study reports on 4 patients with left postpneumonectomy syndrome in the presence of a normally located left aortic arch and ascending thoracic aorta.


METHODS
The case histories of 4 patients with this syndrome were reviewed and several features common to all 4 were noted. In each case, the obstruction was thought to be due to a clockwise rotation of the mediastinum with bronchial compression occurring between the right main pulmonary artery and thoracic spine.


RESULTS
Three patients were treated by repositioning of the mediastinum, and all 3 obtained relief of their dyspnea. In these cases, permanent repositioning was ensured by the insertion of a prosthesis filled with saline solution. The fourth patient was successfully treated by resection of a portion of the adjacent thoracic vertebra.


CONCLUSIONS
Postpneumonectomy syndrome can occur after a left pneumonectomy in the absence of a right aortic arch. We suggest that mediastinal repositioning with a prosthesis filled with saline solution is simple, is safe, and results in complete relief of preoperative symptoms.
Shamji
F M
FM
Division of Thoracic Surgery, Ottawa Civic Hospital, Ontario, Canada.
Deslauriers
J
J
Daniel
T M
TM
Matzinger
F R
FR
Mehran
R J
RJ
Todd
T R
TR
D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology*; D001982:Bronchial Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D019736:Prostheses and Implants; D011859:Radiography; D013577:Syndrome