Bronchial Obstruction after Pneumonectomy

A 42-year-old woman underwent right pneumonectomy because of extensive parenchymal destruction due to tuberculosis. Five years after resection, she reported increasing shortness of breath, wheezing, and dyspnea on exertion. A computed tomographic scan of the chest revealed counterclockwise rotation of the mediastinum, with mediastinal shift and compression of the left-lower-lobe bronchus (LLLB) between the pulmonary artery and aorta (Panel A, arrow), features consistent with the post-pneumonectomy syndrome. Mediastinal repositioning was accomplished with the use of an intrapleural-tissue expander and saline-filled prosthesis. Panel B shows a patent left-lower-lobe bronchus (asterisk) and the saline-filled prosthesis in the right side of the chest . . .