Successful treatment of advanced tuberculosis of a single lung with staged correction of post-pneumonectomy syndrome

Abstract

An observation from practice is given – surgical treatment of a patient with advanced tuberculosis of a single lung and a pronounced lung displacement. Patient A., 47 years old, after 3 months from the left pneumonectomy for fibrocavernous tuberculosis complained of dyspnea at rest, and dysphagia, underwent CT scan, which showed a pronounced displace ment of a single right lung with tuberculoma to the left. At the first stage of the surgery, the overstretched section of a single lung with tuberculoma was resected, the displaced lung was put back and a hernial orifice was strengthened with a mesh implant. At the second stage, the extrapleural thoracoplasty was made with resection of I–IV ribs from the side of pneumonectomy to reduce the volume of the left hemithorax and prevent relapse of mediastinal hernia. As a result, the patient stopped dyspnea and dysphagia, radiographically a single right lung was visualized in the right hemithorax.

Video-assisted thoracoscopic surgery for prevention of postpneumonectomy syndrome: A case report

“…According to foreign authors, PPS is a rare complication occurring in about 2 % of patients who underwent pneumonectomy [ 3 , 5 , 7 , 8 ]. According to Russian authors, postpneumonectomy syndrome with the formation of a pulmonary hernia develops in 81.1 % [ 9 ].…”

“…The primary goal of the procedure is to “suture the sheets of the mediastinal pleura in the region of the anterior and posterior sinuses” [ 18 ], apply Z -shaped sutures between the pericardium and the chest wall following lung removal, or perform a two-stage procedure to treat this complication. The authors' first stage involved performing a thoracotomy on the side with the healthy side while suturing a mesh implant into the area of the hernia gate, a thoracoplasty on the side of the previously completed pneumonectomy is the second stage [ 9 ].…”