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Spirometry showed forced vital capacity &#40;FVC&#41; 3220<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> &#40;62&#37;&#41;&#44; forced expiratory volume in one second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; 1480<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> &#40;36&#37;&#41; and FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio 46&#37;&#46; A computerized axial tomography &#40;CAT&#41; of the chest revealed a hyperexpanded left hemithorax occupying the entire chest cavity as a result of the previous right pneumonectomy&#44; and a right mediastinal shift that placed the heart in an abnormal position due to pulmonary hyperextension&#46; No anomalies were observed in the supra-aortic vessels &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The study was completed with echocardiography and fiberoptic bronchoscopy to rule out cardiac involvement and&#47;or bronchial compression&#46; Doppler echocardiography showed cardiac structures distorted by the mediastinal shift&#44; normal size heart chambers and valves&#44; and normal blood flow&#46; Fiberoptic bronchoscopy confirmed a pneumonectomy scar in good condition and no abnormalities in the main carina and left bronchial tree&#44; thus ruling out bronchial compression secondary to mediastinal shift&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">After 2 months of treatment with high-dose inhaled corticosteroids and long-acting beta-2 adrenergic receptors&#44; the patient reported significant improvement in symptoms&#44; and since no tracheobronchial compression or cardiac or vascular involvement was observed&#44; close follow-up in conjunction with the Thoracic Surgery Unit began&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Post-pneumonectomy syndrome is a late complication of right pneumonectomy&#44; and is caused by mediastinal shifting and counterclockwise rotation toward the vacant hemithorax&#46; As a result&#44; the distal trachea and left main bronchus are compressed between the pulmonary artery and the spinal column or aorta&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> This phenomenon has also been described after left pneumonectomy&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a> and is more common in children&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The most common symptoms are progressive dyspnea&#44; vascular involvement and swallowing disorders&#46; Imaging techniques help establish the diagnosis&#46; Bronchoscopy is essential to evaluate the anatomy of the respiratory tract&#44; as it can show the displacement of the trachea&#44; the rotation of the carina&#44; and indicate the level of obstruction of the respiratory tract&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment of post-pneumonectomy syndrome must be tailored to the characteristics of each patient&#46; Surgery should be considered when the patient presents cardiac or vascular involvement or tracheobronchial compression secondary to mediastinal shift&#46; In these cases&#44; the surgical option is mediastinal repositioning and the use of an intrathoracic prosthesis to restore the normal anatomical architecture of the hemithorax and prevent recurrence of mediastinal shift and rotation&#46; When surgery is not indicated&#44; endobronchial placement of a self-expanding stent can be considered&#44; although this option is only indicated as a complement to mediastinal repositioning&#44; or in cases in which tracheobronchial compression is the only problem&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study did not receive any financial support&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">None of the authors have any conflict of interest&#46;</p></span></span>"
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Case Report
Postpneumonectomy Syndrome in a Patient With Swyer–James–MacLeod Syndrome
Síndrome posneumonectomía en paciente con síndrome de Swyer-James-MacLeod
Cristina Benito Bernáldeza,
Corresponding author
cristina_be_be@hotmail.com

Corresponding author.
, Antonia Mora Juradob, Virginia Almadana Pachecoa
a Servicio de Neumología, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Servicio de Radiodiagnóstico, Hospital Infanta Elena, Huelva, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#41; Chest X-ray showing the cardiac silhouette on the right&#44; with hyperinflation and herniation of the left lung occupying both hemithoraces&#46; B&#41; Contrast-enhanced chest CT &#40;coronal slice&#41; showing vascular permeability and the left main bronchus &#40;&#42;&#41; between the pulmonary artery and the aorta&#46; C and D&#41; Contrast-enhanced CT scan with parenchyma window &#40;axial slices&#41; showing counterclockwise rotation and right shift of mediastinal structures posterior to the lung&#44; left pulmonary hyperinflation with right herniation&#44; and left main bronchus &#40;&#42;&#41; running between the left pulmonary artery and the descending aorta&#44; with normal caliber and no evidence of extrinsic compression&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Post-pneumonectomy syndrome is an unusual complication of pneumonectomy that occurs as a result of excessive displacement of mediastinal structures into the vacant pleural space&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 32-year-old man diagnosed with bronchial asthma who had a history of right pneumonectomy due to Swyer&#8211;James&#8211;MacLeod syndrome&#44; performed when he was 7 years of age&#46; Radiographically&#44; this syndrome is characterized by unilateral hemithorax lucency as a result of postinfectious obliterative bronchiolitis&#44; and is often accompanied by bronchiectasis&#46; In the case of our patient&#44; right pneumonectomy was performed because of recurrent episodes of pneumonia during childhood&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">He came to our consultation with a 5-month history of dyspnea&#46; Spirometry showed forced vital capacity &#40;FVC&#41; 3220<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> &#40;62&#37;&#41;&#44; forced expiratory volume in one second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; 1480<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> &#40;36&#37;&#41; and FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio 46&#37;&#46; A computerized axial tomography &#40;CAT&#41; of the chest revealed a hyperexpanded left hemithorax occupying the entire chest cavity as a result of the previous right pneumonectomy&#44; and a right mediastinal shift that placed the heart in an abnormal position due to pulmonary hyperextension&#46; No anomalies were observed in the supra-aortic vessels &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The study was completed with echocardiography and fiberoptic bronchoscopy to rule out cardiac involvement and&#47;or bronchial compression&#46; Doppler echocardiography showed cardiac structures distorted by the mediastinal shift&#44; normal size heart chambers and valves&#44; and normal blood flow&#46; Fiberoptic bronchoscopy confirmed a pneumonectomy scar in good condition and no abnormalities in the main carina and left bronchial tree&#44; thus ruling out bronchial compression secondary to mediastinal shift&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">After 2 months of treatment with high-dose inhaled corticosteroids and long-acting beta-2 adrenergic receptors&#44; the patient reported significant improvement in symptoms&#44; and since no tracheobronchial compression or cardiac or vascular involvement was observed&#44; close follow-up in conjunction with the Thoracic Surgery Unit began&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Post-pneumonectomy syndrome is a late complication of right pneumonectomy&#44; and is caused by mediastinal shifting and counterclockwise rotation toward the vacant hemithorax&#46; As a result&#44; the distal trachea and left main bronchus are compressed between the pulmonary artery and the spinal column or aorta&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> This phenomenon has also been described after left pneumonectomy&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a> and is more common in children&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The most common symptoms are progressive dyspnea&#44; vascular involvement and swallowing disorders&#46; Imaging techniques help establish the diagnosis&#46; Bronchoscopy is essential to evaluate the anatomy of the respiratory tract&#44; as it can show the displacement of the trachea&#44; the rotation of the carina&#44; and indicate the level of obstruction of the respiratory tract&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment of post-pneumonectomy syndrome must be tailored to the characteristics of each patient&#46; Surgery should be considered when the patient presents cardiac or vascular involvement or tracheobronchial compression secondary to mediastinal shift&#46; In these cases&#44; the surgical option is mediastinal repositioning and the use of an intrathoracic prosthesis to restore the normal anatomical architecture of the hemithorax and prevent recurrence of mediastinal shift and rotation&#46; When surgery is not indicated&#44; endobronchial placement of a self-expanding stent can be considered&#44; although this option is only indicated as a complement to mediastinal repositioning&#44; or in cases in which tracheobronchial compression is the only problem&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study did not receive any financial support&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">None of the authors have any conflict of interest&#46;</p></span></span>"
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ISSN: 03002896
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