Intrathoracic saline-filled prosthesis to treat postpneumonectomy syndrome

摘要

Abstract Postpneumonectomy syndrome is a rare complication following pneumonectomy with its related change in mediastinal configuration. Symptoms range from airway obstruction to esophageal symptoms, leading at times to a persistent requirement for respiratory support. Surgery is often beneficial, which is in the form of placement of a prosthesis, with variable results. We report 2 cases of postpneumonectomy syndrome: one with successful relief, and the other in which the saline-filled prosthesis failed to achieve the desired result. Postpneumonectomy syndrome (PPS) is a rare complication, occurring in approximately 2% of patients who undergo pneumonectomy for various lung pathologies.1 It results from a rotational shift of the mediastinum, often excessive, towards the empty hemithorax from which the patient's lung was removed. This can lead to persistent airway or esophageal obstruction, potentially ending in death. Symptoms are variable, and presentation is often delayed for years. Conservative treatment is rarely helpful, and can be fatal in acute PPS. Surgery to place a prosthesis with either saline or silicone gel, is often needed. Although reports demonstrating individual success stories of placement of such prostheses in chest cavities have been reported in the literature, it is not without difficulties. We report two clinical scenarios with differing results, and discuss the factors that might impact on success in treating PPS.