Division of Pulmonary Medicine, University of Ioannina School of Medicine, University Hospital of Ioannina, S. Niarhou Ave, 45500, Ioannina, Greece.
1st Respiratory Medicine Department, University of Athens, "Sotiria" Hospital, 152 Mesogeion Ave, 115 27, Athens, Greece.
BMC Pulm Med. 2019 Feb 18;19(1):44. doi: 10.1186/s12890-018-0767-5.
Postpneumonectomy-like syndrome is a rare condition resulting from unilateral lung disease with severe lung volume loss leading to excessive mediastinal shift and herniation of the healthy lung into the contralateral hemithorax, mimicking the mediastinal shift observed in postpneumonectomy syndrome after pneumonectomy. We report a unique case of postpneumonectomy-like syndrome caused by an atypical bronchial carcinoid completely occluding the left main bronchus.
A 25-year-old woman presented with symptoms of chronic exertional dyspnea and productive cough. Imaging studies showed complete left lung atelectasis due to a mass occluding the left main bronchus, as well as extreme mediastinal deviation and substantial herniation of the right lung into the left hemithorax. Bronchoscopic biopsy of the tumor and subsequent left pneumonectomy with concurrent lymph node dissection revealed an atypical carcinoid. Sixteen months after surgery the patient has been asymptomatic with repeat imaging studies showing no change in mediastinal shifting.
Bronchial carcinoids are notorious for causing bronchial obstruction. The present case represents an extreme complication of centrally located bronchial carcinoid, resulting in postpneumonectomy-like syndrome with severe mediastinal shift and herniation of the healthy lung into the diseased hemithorax.
类肺叶切除后综合征是一种罕见的病症，由单侧肺部疾病导致严重的肺容积丧失引起，导致纵隔过度移位，健康肺疝入对侧胸腔，类似于肺叶切除术后综合征中的纵隔移位。我们报告了一例由非典型性支气管类癌完全阻塞左主支气管引起的独特的类肺叶切除后综合征病例。
一名 25 岁女性因慢性劳力性呼吸困难和咳痰就诊。影像学检查显示左全肺不张，由肿块阻塞左主支气管引起，同时伴有严重的纵隔移位和右肺大量疝入左胸腔。肿瘤的支气管镜活检和随后的左肺叶切除术及同期淋巴结清扫术显示为非典型类癌。术后 16 个月，患者无症状，重复影像学检查显示纵隔移位无变化。
支气管类癌以引起支气管阻塞而臭名昭著。本病例代表了位于中央的支气管类癌的极端并发症，导致类肺叶切除后综合征，严重的纵隔移位和健康肺疝入病变侧胸腔。
