Pneumonectomy
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Pneumonectomy is the complete surgical removal of the lung. It is most commonly performed for a primary lung malignancy. The lung is removed in its entirety providing the patient has adequate pulmonary reserve from the contralateral lung.
Recognised post-pneumonectomy complications include:
- post pneumonectomy syndrome
- bronchopleural fistula formation
- cardiac herniation
- recurrent pneumothorax
Radiographic appearances
The typical course of chances on imaging following pneumonectomy are:
- acutely, there is partial filling of the hemithorax with a combination of fluid, air and contraleteral lung and mediastinum
- mediastinal shift occurs gradually accompanied by hyperinflation of the contralateral lung and herniation
-
sequential CXRs should demonstrate increasing fluid and decreasing gas within the pneumonectomy space, which is evident by a air-fluid level which gradually rises
- if there air-fluid level starts to lower, a bronchoplueral fistula is suspected
-
sequential CXRs should demonstrate gradual volume loss on the pneumonectomy side
- if there is signs of increasing volume on the pneumonectomy side, then wither bronchoplueral fistula, empyema or haemorrhage is suspected
Plain radiograph
Pneumonectomy is one of the causes of a white out of the hemithorax. The hemithorax is completely opacified with the trachea pulled towards the side of the abnormality. Surgical clips may be identified at the lung hilum.
CT
The lung is absent at the side of surgery, with resultant mediastinal shift and compensatory hyperaerationhyperinflation of the contralateral lung.
-<li><a title="Post-pneumonectomy syndrome" href="/articles/post-pneumonectomy-syndrome">post pneumonectomy syndrome</a></li>- +<li><a href="/articles/post-pneumonectomy-syndrome">post pneumonectomy syndrome</a></li>
-<li>recurrent pneumothorax</li>-</ul><h4>Radiographic appearances</h4><h5>Plain radiograph</h5><p>Pneumonectomy is one of the causes of a <a href="/articles/hemithorax-white-out-differential">white out of the hemithorax</a>. The hemithorax is completely opacified with the trachea pulled towards the side of the abnormality. Surgical clips may be identified at the lung hilum.</p><h5>CT</h5><p>The lung is absent at the side of surgery, with resultant mediastinal shift and compensatory hyperaeration of the contralateral lung.</p>- +<li>recurrent <a title="Pneumothorax" href="/articles/pneumothorax">pneumothorax</a>
- +</li>
- +</ul><h4>Radiographic appearances</h4><p>The typical course of chances on imaging following pneumonectomy are:</p><ul>
- +<li>acutely, there is partial filling of the hemithorax with a combination of fluid, air and contraleteral lung and mediastinum</li>
- +<li>mediastinal shift occurs gradually accompanied by hyperinflation of the contralateral lung and herniation</li>
- +<li>sequential CXRs should demonstrate increasing fluid and decreasing gas within the pneumonectomy space, which is evident by a air-fluid level which gradually rises<ul><li>if there air-fluid level starts to lower, a bronchoplueral fistula is suspected</li></ul>
- +</li>
- +<li>sequential CXRs should demonstrate gradual volume loss on the pneumonectomy side<ul><li>if there is signs of increasing volume on the pneumonectomy side, then wither bronchoplueral fistula, empyema or haemorrhage is suspected</li></ul>
- +</li>
- +</ul><h5>Plain radiograph</h5><p>Pneumonectomy is one of the causes of a <a href="/articles/hemithorax-white-out-differential">white out of the hemithorax</a>. The hemithorax is completely opacified with the trachea pulled towards the side of the abnormality. Surgical clips may be identified at the lung hilum.</p><h5>CT</h5><p>The lung is absent at the side of surgery, with resultant mediastinal shift and compensatory hyperinflation of the contralateral lung.</p>
Images Changes:
Image 6 CT (lung window) ( create )
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