Evaluation of chest computed tomography in patients after pneumonectomy to predict contralateral pneumothorax.
OBJECTIVE
Contralateral pneumothorax is a severe complication after pneumonectomy. We evaluated the mediastinal shift and the residual lung in patients who had undergone pneumonectomy to predict the incidence of contralateral pneumothorax.


METHODS
We evaluated 21 cases of pneumonectomy performed from 1996 to 2006. For this study, we excluded patients with recurrent neoplasm, empyema, or hemothorax. We reviewed the computed tomography (CT) results of 13 patients who had undergone pneumonectomy to compare the bullae in the residual lungs, carina shifts, and herniation of the residual lungs before and after pneumonectomy. When evaluating the degree of herniation 4-6 cm below the carina, the anterior and posterior pulmonary hernias were classified as grade A, B, or C. We also investigated the preoperative respiratory function in all 13 patients. Results. Two patients suffered contralateral pneumothorax after left pneumonectomy. Both patients who suffered contralateral pneumothorax after pneumonectomy had bullae. The percentage forced expiratory volume in 1 s (FEV(1.0%)) was <70% in these two patients. Carina shifts and lung herniation were found to be greater after left pneumonectomy than after right pneumonectomy.


CONCLUSIONS
The bullae in the lung and obstructive pulmonary disease are associated not only with spontaneous pneumothorax but also with contralateral pneumothorax after pneumonectomy. Lung herniation and mediastinal shift are greater after left pneumonectomy than after right pneumonectomy, which may be related to contralateral pneumothorax after pneumonectomy.
Maniwa
Tomohiro
T
Department of Thoracic and Cardiovascular Surgery, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, Japan. maniwat@hirakata.kmu.ac.jp
Saito
Yukihito
Y
Saito
Tomohito
T
Kaneda
Hiroyuki
H
Imamura
Hiroji
H
D000328:Adult; D001768:Blister / Q000150:complications / Q000000981:diagnostic imaging; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D006547:Hernia / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome