Pediatr Emerg Care 2010 Jul 01;267:499-502. doi: 10.1097/PEC.0b013e3181e5bfb3.

Right pneumonectomy syndrome: a late life-threatening complication of pneumonectomy.

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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. CASE: 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.

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