Left Postpneumonectomy Syndrome Successfully Treated with Endobronchial Stent.

Nakamura, Yoshinori; Ohata, Masahiro; Kawabe, Kazumi; Ueda, Akiko; Itoh, Kohji; Fujimoto, Hisashi; Kishi, Kazushi

doi:10.2169/internalmedicine.37.880

Cited by 12 publications

(5 citation statements)

References 8 publications

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“…of patients) OCEBM score Harney et al [ 12 ] 1 Metallic stent 49 y LRTI 30 mo Good Y: re-stenting 4 Moser et al [ 14 ] 1 Silastic stent 12 y Good 5 mo Died: alcohol intoxication and aspiration N 4 Abe et al [ 17 ] 1 2 metallic stents 3 y Good 12 y Recurrent LRTIs. Died—respiratory failure N 4 Nakamura et al [ 13 ] 1 Balloon dilation 10 y Poor; stent inserted 3 mo Died–MI N 4 Cordova et al [ 30 ] 1 2 metallic stents 4 y Good 1 y Good N 4 Stratakos et al [ 38 ] 1 Metallic stent 2 y Poor 6 mo Died–PE Y: silastic stent insertion 4 mo Months; y Years OCEMB Score: 1a—SR of RCTs;...…”

Section: Resultsmentioning

confidence: 99%

“…Four of the 6 patients died during the follow-up period; one died of a PE and the other of respiratory failure 6 months and 12 years later, respectively [ 37 , 38 ]. Nakamura et al reported a case of endobronchial stenting following failed endobronchial balloon dilation with limited follow-up [ 13 ]. Moser et al described the successful use of a silastic stent with limited follow-up (n = 1) [ 14 ] (Table 5 ).…”

Section: Resultsmentioning

confidence: 99%

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Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options

Christodoulides

Fitzmaurice

Bukowska

et al. 2023

J Cardiothorac Surg

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Objectives Post-pneumonectomy syndrome (PPS) is rare and predominantly characterised by dynamic airway obstruction due to mediastinal rotation at any time point following pneumonectomy. The objective of this systematic review was to identify the optimal treatment strategy for PPS based on subjective symptomatic relief, objective radiological imaging, and treatment durability. Methods A systematic review was performed up to and including February 2022 based on the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” guidelines. All studies that presented the management of symptomatic patients > 16 years of age with radiologically confirmed PPS were included. The primary outcome was the identification of the optimal treatment strategy and the secondary outcome was durability of the treatment. The Oxford Centre for Evidence Based Medicine level was assigned to each study. Results A total of 330 papers were identified and reviewed; 41 studies met the inclusion criteria. Data including patient demographics, indication for initial pneumonectomy, presenting symptoms, management approach, outcomes, and follow-up were assessed and analysed. Management approaches were divided into three categories: (a) mediastinal repositioning using implant prostheses; (b) endobronchial stenting; (c) other corrective procedures. One hundred and four patients were identified in total and of those, 87 underwent mediastinal repositioning with insertion of a prosthetic implant. Complications included over- or under-filling of the prosthesis (8.5%) and implant leakage (8.9%). Conclusion Management of PPS using a prosthetic implant to reposition the mediastinum is the treatment of choice. Key adjuncts to optimise surgical approach and minimise complications include pre-operative CT volumetric analysis to guide implant size and intra-operative transoesophageal echocardiography to guide mediastinal repositioning.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options

Christodoulides

Fitzmaurice

Bukowska

et al. 2023

J Cardiothorac Surg

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“…Previous studies have reported several articles on the treatment of PPS, including tissue expander implantation [ 3 – 6 ], gas injection [ 7 , 8 ] and stenting [ 9 ]. Unfortunately, tissue expanders for thoracic cavity stabilization are not approved for use in Japan due to insurance regulations, which limits their availability for emergency surgery.…”

Section: Discussionmentioning

confidence: 99%

SF6 is a useful expander for post-pneumonectomy syndrome in the long-term course: a case report

Maeda,

Imamura,

Tabata

et al. 2024

surg case rep

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Background Post-pneumonectomy syndrome (PPS) is a rare but serious condition that can occur after pneumonectomy. It is characterized by a mediastinal shift towards the vacated hemithorax, which can potentially lead to respiratory failure. The management of PPS poses a clinical challenge, especially in the context of the limited availability of certain therapeutic devices due to regulatory restrictions in Japan. Case presentation A 36-year-old female with stage IB non-small cell lung cancer underwent left pneumonectomy. Approximately 2 years later, she developed dyspnea. After consulting with our hospital, subsequent imaging revealed an extreme mediastinal shift causing bronchial obstruction. Emergency thoracotomy and subsequent sulfur hexafluoride (SF6) injections were successfully used to manage her condition. Over the course of follow-up, the interval between SF6 injections was extended from 3 to 11 months, indicating an improvement in the intrathoracic condition. Conclusions This case illustrates the efficacy of SF6 gas in treating PPS and in reducing the frequency of medical interventions. SF6 gas administration is safe and effective for the treatment of patients with PPS.

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“…El diagnóstico exige una historia clínica detallada, examen físico, radiografías de tórax, tomografía computada, pruebas de función pulmonar y broncoscopia; una vez establecido, el tratamiento continúa siendo un desafío. 1-4.6 Los tutores endoluminales (stents) de silastic tienen la ventaja de su fácil adecuación, reposición y remoción, 8,9 pero se han comunicado, como inconvenientes mayores, la migración y la obstrucción. Los tutores metálicos autoexpandibles tienen la ventaja de una fácil inserción, conformación a la vía aérea y estabilidad.…”

Section: Discussionunclassified

Síndrome postneumonectomía derecha: informe de un caso

et al. 2012

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Presentación de casos clínicos RESUMENEl síndrome postneumonectomía es una entidad poco frecuente en pediatría. Comunicamos un caso secundario a una neumonectomía realizada por un tumor intratorácico. Niño de 4 años con antecedente de exéresis pulmonar derecha y dificultad respiratoria progresiva, con obstrucción extrínseca de la vía aérea por estructuras mediastínicas desplazadas. Hubo intentos frustros de tutorización con dispositivos endoluminales de la vía aérea, e imposibilidad de retiro de la asistencia ventilatoria mecánica. Ante la imposibilidad de reposicionamiento mediastinal, se realiza puente (bypass) aórtico con tubo protésico, con evolución favorable y egreso hospitalario. Palabras clave: síndrome postneumonectomía, bypass aórtico, neumonectomía. ABSTRACTPostpneumonectomy syndrome is a rare entity in children. We report a case secondary to pneumonectomy performed due to an intrathoracic tumor. A 4-year-old boy with a history of right pneumonectomy and progressive respiratory distress, with extrinsic airway obstruction due to displaced mediastinal structures. There were failure to intubate the airway with endoluminal devices and impossibility of withdrawing from mechanical ventilation. As mediastinal repositioning was not possible, an aortic bypass with a prosthetic tube graft was performed, with favorable outcome and hospital discharge.http://dx.doi.org/10.5546/aap.2012.e114 INTRODUCCIÓNEl síndrome postneumonectomía (SPN) es una rara complicación que ocurre después de resecar un pulmón. Se produce debido a la herniación del pulmón remanente y del contenido mediastí-nico en el espacio torácico vacío; existe desplazamiento y rotación de las estructuras anatómicas del mediastino. La tráquea distal se desplaza, los bronquios primarios o los bronquios del lóbulo inferior resultan elongados y comprimidos entre la arteria pulmonar por delante y la aorta o la columna por detrás.1-3 Como consecuencia de esta compresión extrínseca, el paciente presenta disnea grave y progresiva, y el cuadro puede conducir a una malacia secundaria de los cartílagos de la vía aérea.El SPN fue inicialmente descrito exclusivamente después de la neumonectomía del lado derecho, pero se han comunicado casos después de una neumonectomía izquierda con arcos aórticos derechos y sin ellos. 4,5 El síndrome ocurre en todos los grupos etarios, pero es más común en niños y adultos jóvenes. 2A través de los años se han comunicado diferentes alternativas de tratamiento. Se ha intentado el reposicionamiento mediastinal para que la formación de tejido cicatrizal prevenga una recidiva.2 Las tasas más bajas de recidiva se alcanzaron cuando el reposicionamiento mediastinal fue mejorado con la colocación de un dispositivo protésico en el espacio postneumonectomía para prevenir la recurrencia.2,3,6 Además, los síntomas obstructivos pueden persistir después del reposicionamiento mediastinal en casos de malacia. 5Un tratamiento alternativo consiste en la colocación broncoscópica de un tutor endobronquial; no obstante, el resultado a largo plazo y la ...

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Left Postpneumonectomy Syndrome Successfully Treated with Endobronchial Stent.

Cited by 12 publications

References 8 publications

Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options

Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options

SF6 is a useful expander for post-pneumonectomy syndrome in the long-term course: a case report

Síndrome postneumonectomía derecha: informe de un caso

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