Right pneumonectomy syndrome: a late life-threatening complication of pneumonectomy.
BACKGROUND
Right pneumonectomy syndrome, a rare complication of pneumonectomy, is secondary to a shift of the mediastinum and remaining lung toward the pneumonectomy side, leading to extrinsic airway compression and stretching.


METHODS
A 6-year-old boy started with initial symptoms of dyspnea on exertion, wheezing, and recurrent pneumonia 6 months after his right pneumonectomy. He received treatment with bronchodilators and antibiotics during outpatient clinic visits. Two months later, he developed increased wheezing and productive cough. A pulmonary function test showed severe reduction in expiratory volumes. He had a cardiopulmonary arrest while a surgical intervention was being planned. Chest roentgenogram showed shift of the heart and mediastinal structures into the right hemithorax with left lung hyperexpansion and no fluid in the right hemithorax. A computed tomogram of the chest revealed marked narrowing of the proximal left mainstem bronchus. He underwent thoracotomy, and a silicone prosthesis was inserted into the right hemithorax, resulting in restoration of the structures to the midline. The child presented severe neurological sequelae.


CONCLUSIONS
Postpneumonectomy syndrome is a rare but life-threatening complication after pneumonectomy. Because it may mimic other conditions and given the consequences can be devastating, early recognition and intervention are required to ensure a favorable outcome.
da Silva
Paulo Sérgio Lucas
PS
Department of Pediatrics, Hospital Estadual de Diadema-Universidade Federal de São Paulo, São Paulo, Brazil. psls.nat@terra.com.br
de Oliveira
Renato
R
Tamura
Nikkei
N
Neto
Henrique Monteiro
HM
D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002648:Child; D006323:Heart Arrest; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology; D008297:Male; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis; D019736:Prostheses and Implants; D013577:Syndrome