postpneumonectomy

Postpneumonectomy refers to the clinical state that follows pneumonectomy, the surgical removal of a lung. After removal, the pleural cavity on the operated side remains empty and gradually fills with fluid and scar tissue. The mediastinum tends to shift toward the side of the operation, and the remaining lung expands to occupy part of the chest. These anatomic changes alter thoracic mechanics and can influence breathing and cardiovascular function for years.

The postoperative course varies. Early problems include pain, shallow breathing, atelectasis, and infection. Over time, many patients adapt to reduced lung volume, but some experience persistent dyspnea on exertion due to lower overall pulmonary reserves. A well-recognized late complication is postpneumonectomy syndrome, where mediastinal shift compresses the trachea, bronchi, or major vessels, causing wheeze, cough, or severe dyspnea, particularly when upright or in certain positions. Other issues can include empyema, bronchopleural fistula, lymphatic or pleural complications, and spinal or chest wall deformities from mediastinal remodeling.

Diagnosis relies on imaging and functional testing. Chest radiographs typically show mediastinal shift toward the operated side and elevation of the remaining hemidiaphragm; CT or MRI clarifies airway or vascular compression and detailed anatomy. Pulmonary function tests reveal reduced lung volumes with preserved or near-normal gas exchange in some patients.

Management focuses on symptom control and complication treatment. Routine care includes pain control, respiratory therapy, and rehabilitation. Interventions for PPS or airway/vessel compression may involve endobronchial stents, mediastinal fixation procedures, or surgical realignment. Treatment of infections or fistulas follows standard infectious disease and thoracic surgical principles. Prognosis depends on the underlying disease and comorbidities, with many patients adapting to single-lung physiology over time.