title: [Remarkable rightward shift of the mediastinum during a urological operation in the left kidney position--a case report].
abstract: Mediastinal rightward shift without involving cardiovascular collapse and dyspnea occurred after a left nephroureterectomy. An 86-year-old female (height, 142 cm; weight, 53 kg) with ureteral cancer was scheduled for an elective nephroureterectomy. Preanesthetic electrocardiogram revealed supraventricular premature contractions and sinus tachycardia (116 beats.min-1) and preanesthetic chest X-ray film revealed cardio-thoracic ratio of 60% and pleural adhesion of the right apex of the lung. Anesthesia was maintained with a combination of inhalation anesthetics (oxygen, nitrous oxide and sevoflurane) and thoracic epidural lidocaine. Artificial ventilation was used during the anesthesia. The operation was uneventful. A chest radiograph taken at the end of the operation demonstrated a large mass-like shadow in the right field of the lung. However, dyspnea or cardiovascular collapse was not observed. The vesicular sounds were auscultated in the left lung field. Results of arterial blood gas analysis during spontaneous respiration were within normal ranges. A CT scanning of the chest showed that the great vessel and the heart had been in the right thoracic cavity. Therefore, we considered that a rightward mediastinal shift had occured during the operation.
authors.affiliation: Department of Anesthesia, Tsuruga City Hospital, Tsuruga 914-8502.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sugiura
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamada
authors.forename: Mari
authors.initials: M
authors.lastname: Ishiguro
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Isada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D000769:Anesthesia, Inhalation; D005260:Female; D006801:Humans; D008482:Mediastinum / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011187:Posture / Q000502:physiology; D014057:Tomography, X-Ray Computed; D013520:Urologic Surgical Procedures