Evaluation of chest computed tomography in patients after pneumonectomy to predict contralateral pneumothorax

Maniwa, Tomohiro; Saito, Yukihito; Saito, Tomohito; Kaneda, Hidehiro; Imamura, Hiroji

doi:10.1007/s11748-008-0322-z

Cited by 10 publications

(4 citation statements)

References 12 publications

(20 reference statements)

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“…Posterior lung herniation can also occur in patients undergoing pneumonectomy. However, none of these patients in the previous reports showed a posterior lung herniation crossing the descending thoracic aorta [14][15][16][17]. These findings allow us to assume that "posterior lung herniation beyond the aorta" may not occur when the left lung absence is not congenital (which is, after a left pneumonectomy).…”

Section: Author Contributionsmentioning

confidence: 72%

Posterior Lung Herniation in Pulmonary Agenesis and Aplasia: Chest Radiograph and Cross-Sectional Imaging Correlation

Kim

Lee

et al. 2021

Korean J Radiol

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Objective: To describe the anatomic locations and imaging features of posterior lung herniation in unilateral pulmonary agenesis and aplasia, focusing on radiograph-CT/MRI correlation. Materials and Methods: A total of 10 patients (seven with pulmonary agenesis and three with pulmonary aplasia, male: female = 1:9, mean age 7.3 years, age range from 1 month to 20 years) were included. Chest radiographs (n = 9), CT (n = 9), and MRI (n = 1) were reviewed to assess the type of lung underdevelopment, presence of anterior and posterior lung herniation, bronchus origin, supplying artery, and draining vein of the herniated lung. Results: Pulmonary agenesis/aplasia more commonly affected the left lung (n = 7) than the right lung (n = 3). Anterior lung herniation was observed in nine of the 10 patients. Posterior lung herniation was observed in seven patients with left pulmonary agenesis/aplasia. Two patients showed posterior lung herniation crossing the midline but not beyond the aorta, and five patients showed the posteriorly herniated right lower lobe crossing the midline to extend into the left hemithorax farther beyond the descending thoracic aorta through the space between the esophagus and the aorta. This anatomical configuration resulted in a characteristic radiographic finding of a radiolucent area with a convex lateral border and a vertical medial border in the left lower lung zone, revealing a tongue-like projection on CT and MRI. Conclusion:Posterior lung herniation occurs in unilateral left lung agenesis/aplasia. Approximately 70% of the cases of posterior lung herniation reveal a unique radiolucent tongue-like projection in the left lower lung zone on imaging studies, which is caused by the extension of the posteriorly herniated right lung farther beyond the descending aorta.

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Section: Author Contributionsmentioning

confidence: 72%

Posterior Lung Herniation in Pulmonary Agenesis and Aplasia: Chest Radiograph and Cross-Sectional Imaging Correlation

Kim

Lee

et al. 2021

Korean J Radiol

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“…the contralateral lung across the midline posterior to the heart also occurs in patients with a left pneumonectomy (6,7). In the case of autopneumonectomy, a similar process with progressive mediastinal shift and contralateral lung herniation into the autopneumonectomy space may occur.…”

Section: Discussionmentioning

confidence: 99%

Contralateral Pneumothorax Mimicking Bilateral Pneumothoraces in a Patient with Autopneumonectomy

Park

et al. 2016

Iran J Radiol

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Contralateral pneumothorax crossing the midline in a patient with autopneumonectomy can mimic bilateral pneumothoraces on chest radiography. In this study, we report a rare case of right pneumothorax mimicking bilateral pneumothoraces in a patient with left autopneumonectomy. A 37-year-old man complained of progressive chest pain and dyspnea. The initial chest radiography revealed visible visceral pleura with air in bilateral upper pleural spaces, suggesting bilateral pneumothoraces. Mediastinal structures were shifted to the left side and increased opacities with internal tubular and cystic radiolucencies were noted in the left lower lung zone. After immediate placement of a drainage tube into the right pleural space, the patient underwent chest computed tomography (CT). CT scan revealed a destroyed and totally collapsed left lung and hyper-inflated right lung with right pneumothorax crossing the midline. The contralateral pneumothorax was then gradually absorbed by keeping the chest tube in the right hemithorax. No pneumothorax recurred in 2 years of follow-up. A greater awareness of this rare condition is important in clinical practice, as catastrophic consequences can occur if a chest tube is blindly placed in the autopneumonectomy site.

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“…First, a sudden increased pressure in the contralateral lung during occluder deployment procedure (reinforced by decrease of airflow through the ipsilateral lung) could cause a defect in the visceral pleura and result in a pneumothorax [20]. Second, possible procedure-related trauma such as airway injury by the occluder introducer system or inadvertent guidewire traversing through the lung parenchyma, could result in pneumothorax in the contralateral lung [20]. Fortunately, the pneumothorax completely resolved during the 2-week follow-up in all rabbits.…”

Section: Discussionmentioning

confidence: 99%

Experimental lung collapse following deployment of a self-expandable bronchial occluder in a rabbit model

Cho

Shin

et al. 2012

BJR

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Objectives: Closure of a bronchopleural fistula is required to prevent fatal empyema or aspiration pneumonia. The purpose of this study was to determine the feasibility and efficacy of bronchial occlusion with a self-expandable occluder to induce experimental lung collapse in a rabbit model. Methods: 10 bronchial occluders (wine glass appearance; 8 mm in diameter and 15 mm in length) were implanted in the native left main bronchi of 10 rabbits via an endotracheal route. We analysed the following: (1) diameters and morphological changes of the bronchial occluders during follow-up; (2) percentage volume of the collapsed lung during follow-up; and (3) complications and gross pathology. 1-day and 2-week follow-up CT scans were routinely obtained. Rabbits were sacrificed 4 weeks after the experiment. Results: In all 10 rabbits, the bronchial occluders were successfully implanted and were completely expanded within 2 weeks. Complete collapse of the left lung occurred in three rabbits on day 1 and in an additional two rabbits 2 weeks following implantation. Two other rabbits maintained the percentage volume of the collapsed lung between 51% and 99% during follow-up; the other three rabbits had ,50% during follow-up. Pneumothoraces occurred in nine rabbits, but completely resolved at the 2-week follow-up. Right lung herniation across the midline progressed 2 weeks after occluder implantation. Conclusion: Placement of self-expandable occluders in a rabbit bronchus model was feasible and showed a potential to induce artificial lung collapse. While pneumothoraces were common, they resolved during follow-up.

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Evaluation of chest computed tomography in patients after pneumonectomy to predict contralateral pneumothorax

Cited by 10 publications

References 12 publications

Posterior Lung Herniation in Pulmonary Agenesis and Aplasia: Chest Radiograph and Cross-Sectional Imaging Correlation

Posterior Lung Herniation in Pulmonary Agenesis and Aplasia: Chest Radiograph and Cross-Sectional Imaging Correlation

Contralateral Pneumothorax Mimicking Bilateral Pneumothoraces in a Patient with Autopneumonectomy

Experimental lung collapse following deployment of a self-expandable bronchial occluder in a rabbit model

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