ABSTRACT
BACKGROUND: 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. CASE PRESENTATION: 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. CONCLUSION: 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.
Subject(s)
Airway Obstruction/etiology , Bronchial Neoplasms/complications , Carcinoid Tumor/complications , Hernia/etiology , Lung Diseases/etiology , Adult , Airway Obstruction/diagnostic imaging , Airway Obstruction/surgery , Bronchial Neoplasms/diagnostic imaging , Bronchial Neoplasms/surgery , Carcinoid Tumor/diagnostic imaging , Carcinoid Tumor/surgery , Female , Hernia/diagnostic imaging , Humans , Lung Diseases/diagnostic imaging , Pneumonectomy , Postoperative Complications , SyndromeABSTRACT
Globally, lung cancer remains the leading cause of cancer-related death. Annual low-dose computed tomography has been recommended as a screening test for early detection of lung cancers. Implementing this screening strategy is expected to challenge pulmonologist to confirm the nature of the increasing number of detected pulmonary nodules. Clinicians are obliged to use the less invasive and most efficient and safe means to set diagnoses. Hence, the field of diagnostic modalities, especially the advanced diagnostic bronchoscopy is witnessing rapid evolution to fulfill these unmet needs. This review highlights the available diagnostic modalities, describes their advantages and discusses the limitations of each technique. It also suggests an integrated diagnostic algorithm based on the best available evidence. A search of the PubMed database was conducted using relevant terms described at methodology; only articles in English were reviewed by November 2016.
