Improved expandable prosthesis in postpneumonectomy syndrome with deformed thorax

Postpneumonectomy syndrome is a rare complication of pneumonectomy. The mediastinum, heart, and lung shift into the postoperative thoracic space, and the trachea deviates to the posterior contralaterally after pneumonectomy, causing symptomatic airway compression. Prevention or treatment of postpneumonectomy syndrome with various procedures has been reported. We report the case of a patient in whom the right thorax was deformed and right pneumonectomy was performed because of laceration of the right main bronchus as a result of a traffic accident that led to progressive exertional dyspnea. It was successfully managed with an improved expandable prosthesis. Clinical summary. A 37-year-old man underwent reconstruction of the right chest wall and trachea and right pneumonectomy for laceration of the right main bronchus as the result of a traffic accident on August 21, 1994. Approximately 1 year later, he complained of exertional dyspnea, an increased cough, and sputum production. Bronchoscopy revealed tracheal stenosis caused by postinflammatory change; there was no stenosis of the left main bronchus, and the right main bronchial stump was clear. A Dumon stent (16 mm × 70 ram) was positioned in the trachea. Two years after the operation, he experienced frequent pulmonary infections and bronchitis. Computed tomography showed gross herniation of the left lung into the right hemithorax and rightward mediastinal shill with compression of the left main bronchus stretched over the vertebral column and aorta (Fig. 1). Arterial blood gases showed moderate hypoxemia, and pulmonary function tests showed a moderate reduction in pulmonary overdistention (forced vital capacity [FVC] 2.05 L; forced expiratory volume in 1 second/forced vital capacity ( F E V J FVC) ratio, 0.87; peak expiratory flow rate, 3.88 L/s; maximum mid-expiratory flow rate, 2.39 L/s; Paco2, 51.2 mm Hg; Pao2, 88.8 mm Hg). Analyzing the shape and capacity of the right deformed thorax from 3-dimensional computed tomography, a silicone rubber expandable prosthesis (820 ml, 130 L × 190 Wmax × 50 mm H) was made to occupy the intrathoracic space as nmch as possible