Late-onset post-pneumonectomy empyema.

Kerr, W. F.

doi:10.1136/thx.32.2.149

Cited by 27 publications

(21 citation statements)

References 9 publications

(5 reference statements)

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“…The first pneumonectomy dates back to the 1890s when William Macewen performed the procedure in multiple surgical stages. 1 In 1933, the first single stage en block resection was accomplished by Graham and Singer. [2][3][4][5] Today, there are two surgical types of pneumonectomy performed.…”

Section: Discussionmentioning

confidence: 99%

Post-Pneumonectomy Changes

Bennin¹

2010

TMF

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A 71-year-old woman, with a history of non-small cell lung cancer (NSCLC) with subsequent pneumonectomy presented with worsening dyspnea on exertion and non-productive cough.The patient first noted the shortness of breath and cough 4 weeks prior to presentation, which were refractory to albuterol nebulization. The patient also reported a 6 lb. weight loss during this time period. She denied fevers, chills, night sweats or chest pain. The patient was diagnosed with NSCLC 11 years ago and underwent a right-sided extrapleural pneumonectomy at that time. She received no radiation or chemotherapy. She did not require home oxygen and reported a generally good functional status prior to the development of her latest symptoms. Other past medical history included hyperlipidemia. The patient had been smoking a pack of cigarettes per day for the past 35 years, but denied alcohol or illicit drug use. Current medications included albuterol nebulizer, aspirin, alprazolam, levothyroxine, simvastatin, and over-the-counter Excedrin (acetaminophen, aspirin, caffeine).On examination, the patient appeared in minimal respiratory distress. She was afebrile, blood pressure was 110/60 mm Hg, the pulse 97 beats per minute, the respiratory rate 16 breaths per minute, and the oxygen saturation 95% on ambient air. Her heart exam had no murmurs, rubs, or gallops. There were coarse breath sounds over the lower field of the left lung and decreased breath sounds with egophony at the right base. There was no lower extremity edema or calf tenderness. White blood cell count was within normal limits without a bandemia. Chest radiography revealed opacification of the right hemithorax with overall volume loss and left-to-right mediastinal and tracheal shift in keeping with prior right pneumonectomy. There were several surgical clips seen in the right hemithorax. The left lung field was unremarkable without pneumothorax, pleural effusion, pulmonary edema or focal consolidation. The cardiomediastinal silhouette evaluation was severely limited due to significant left-to-right mediastinal shift. The chest radiograph was interpreted by radiology as "stable post-pneumonectomy changes with no effusions, edema or consolidation." A computed tomography scan was revealed hilar adenopathy with mass effect as well as a new 3 mm nodule in the left lower lobe.

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Section: Discussionmentioning

confidence: 99%

Post-Pneumonectomy Changes

Bennin¹

2010

TMF

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“…of the postpneumonectomy space is present on the chest radiograph, the sudden appearance of air-fluid levels can be the clue to the diagnosis [4]. However, in some cases, fluid may remain in the postpneumonectorny space indefinitely.…”

Section: Discussionmentioning

confidence: 99%

“…A patient has been found to have fluid within the postpneumonectomy space 1 4 years after pneumonectomy [4]. Shift of the trachea and mediastinal contents back to the midline on conventional chest radiography has been described as a useful sign in evaluation for empyema.…”

Section: Discussionmentioning

confidence: 99%

“…Shift of the trachea and mediastinal contents back to the midline on conventional chest radiography has been described as a useful sign in evaluation for empyema. However, in one series, only one patient of nine with clinically proven empyema had shift of the trachea [4]. Shift of the trachea may be subtle and also occurs in other conditions (e.g., recurrent disease, bronchopleural fistula, and hemothorax or chylothorax) [5].…”

Section: Discussionmentioning

confidence: 99%

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CT evaluation of empyema in the postpneumonectomy space

Heater

Revzani

Rubin

1985

American Journal of Roentgenology

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“…Recently it has also been observed in postpneumonectomy and lung transplantation patients. 2,4,13 Associated etiologic pyogenic bacteria from lung abscesses include Pneumococcus, Staphylococcus, Streptococcus and Pseudomonas. 10,13 In actinomycosis, the organism is usually due to Actinomyces israelii, a gram-positive, anaerobic bacterium, frequently originating in a diseased gingiva, poorly cleaned teeth and infected tonsillar crypts.…”

Section: Discussionmentioning

confidence: 99%