Loss of pleural fluid level postpneumonectomy

Description

A 73-year-old woman presented to a thoracic surgical clinic reporting of increased shortness of breath associated with a cough, productive of copious amounts of yellow stained fluid. She had undergone a right intrapericardial pneumonectomy 4 weeks previously for a T4N2M0 primary lung adenocarcinoma. The clinic chest X-ray demonstrated loss of the fluid level (figure 1) compared with a film taken 3 weeks previously (figure 2). A subsequent bronchoscopy demonstrated a bronchopleural fistula. She was admitted under a thoracic surgical team and underwent thoracotomy and bronchial stump repair using a muscle flap. The thoracotomy was not closed to allow packing of the thoracic cavity with iodine soaked swabs (figure 3). She was discharged home 190 days later following closure of the thoracostomy window after three negative thoracic cavity swabs.

Learning points

A pleural effusion is anticipated after pneumonectomy due to fluid filling...

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