• Tuberculosis and Respiratory Diseases
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• v.56 no.3
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• pp.321-323
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• 2004

A-59-year old man was admitted to the hospital with a 2-month history of the right pleuritic chest discomfort and mild dyspnea. Seven years earlier, he was operated on left pneumonectomy for squamous cell carcinoma of left upper lobe (Stage IIb, $T_2N_1M_0$). The computed tomographic scan revealed an anterior herniation of the right lung in the left hemithorax. A single thorax after receiving pneumonectomy is called a "buffalo chest" because the absence of an anatomical separation of the two hemithoraxes resembles that of the North American buffalo or bison. A possible pneumothorax should be catastrophic for the patient, so he should be closely monitored regarding any invasive procedure or trauma. He improved after symptomatic treatment.

• Journal of Chest Surgery
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• v.27 no.5
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• pp.413-417
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• 1994

Adenoid cystic carcinoma usually grows in the trachea or near its bifurcation and causes obstruction of the air way. We recently experienced a 33 year-old male patient who had adenoid cystic carcinoma in the left main bronchus with the chief complaint of productive cough. On the bronchoscopy, the mass obstructed the left main bronchus completely and had nodularity and increased vascularity.The trachea was shifted to the left side and the lower lobe of the left lung was atelectatic on chest X-ray and computed axial tomogram.He underwent left tracheal sleeve pneumonectomy and lymph node dissection through bilateral thoracotomy. At first,we attempted left tracheal sleeve pneumonectomy through the left thoracotomy,however, it was very difficult to perform carinoplastic procedure after sleeve resection of 2.5cm of distal trachea and 1cm of proximal right main bronchus including whole left lung because of poor operative field and difficulty in the anastomosis of the right main bronchus to the distal end of the trachea without tension.Therefore after radical resection of the left lung we made right thoracotomy,through which we could anastomosed the distal trachea and right main bronchus with 4-0 PDS interrupted suture after mobilization of the right hilum without difficulty. The tumor was confirmed to be adenoid cystic carcinoma with metastasis to subcarinal lymph node histopathologically. Postoperative course was uneventful but he needed two bronchoscopic procedure to clear distal airway of the retained bronchial secretion. He was discharged at 14 days after operation with complete recovery.

• Journal of Chest Surgery
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• v.45 no.2
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• pp.110-115
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• 2012

Background: Pneumonectomy remains the ultimate curative treatment modality for destroyed lung caused by tuberculosis despite multiple risks involved in the procedure. We retrospectively evaluated patients who underwent pneumonectomy for treatment of sequelae of pulmonary tuberculosis to determine the risk factors of early and long-term outcomes. Materials and Methods: Between January 1980 and December 2008, pneumonectomy or pleuropneumonectomy was performed in 73 consecutive patients with destroyed lung caused by tuberculosis. There were 48 patients with empyema (12 with bronchopleural fistula [BPF]), 11 with aspergilloma and 7 with multidrug resistant tuberculosis. Results: There were 5 operative mortalities (6.8%). One patient had intraoperative uncontrolled arrhythmia, one had a postoperative cardiac arrest, and three had postoperative respiratory failure. A total of 29 patients (39.7%) suffered from postoperative complications. Twelve patients (16.7%) were found to have postpneumonectomy empyema (PPE), 4 patients had wound infections (5.6%), and 7 patients required re-exploration due to postoperative bleeding (9.7%). The prevalence of PPE increased in patients with preoperative empyema (p=0.019). There were five patients with postoperative BPF, four of which occurred in right-side operation. The only risk factor for BPF was the right-side operation (p=0.023). The 5- and 10-year survival rates were 88.9% and 76.2%, respectively. The risk factors for late deaths were old age (${\geq}50$ years, p=0.02) and low predicted postoperative forced expiratory volume in one second (FEV1) (< 1.2 L, p=0.02). Conclusion: Although PPE increases in patients with preoperative empyema and postoperative BPF increases in right-side operation, the mortality rates and long-term survival rates were found to be satisfactory. However, the follow-up care for patients with low predicted postoperative FEV1 should continue for prevention and early detection of pulmonary complication related to impaired pulmonary function.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.462-469
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• 2006

Background: Pneumonectomy for inflammatory lung disease has been of major concern because of its associated morbidity and mortality, particularly with respect to pleuropneumonectomy. The purpose of this study is to evaluate the surgical outcomes, and identify the risk factors contributing to postoperative complications in patients undergoing pleuropneumonectomy. Material and Method: Ninety-eight patients underwent pneumonectomy for benign inflammatory lung disease were retrospectively analyzed. Pleuropneumonectomy (Group A) was done in 48 patients and standard pneumonectomy (Group B) was done in 50 patients. Clinical characteristics, postoperative complications were examined and compared between 2 groups. In pleuropneumonectomy group, postoperative risk factors affecting morbidity were evaluated. Result: There was one in-hospital death. Twenty-three major postoperative complications occurred in 21 patients (21.4%). The common complications were empyema and bronchopieural fistula (BPF) in 8 (8.4%), re-exploration due to bleeding in 8. At least one postoperative complication occurred in 14 of 48 patients from Group A (29.2%) and in 7 of 50 patients from Group B (14%). In Group A, empyema and BPF encountered in 6 and re-exploration for bleeding in 6 were the most common complication. In univariate analysis, right pneumonectomy, completion pneumonectomy, large amount of blood loss (>1,000 mL), and intrapleural spillage were risk factors contributing to postoperative complications in Group A. In multivariate analysis, intrapleural contamination during operation was a risk factor of postoperative complication. Conclusion: The morbidity and mortality rates of pneumonectomy for chronic inflammatory lung disease are acceptably. However, we confirm that pleuropneumonectomy is a real technical challenge and a high-risk procedure and technically demanding. Meticulous surgical techniques are very important in preventing serious and potentially lethal complications.

• Journal of Chest Surgery
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• v.21 no.6
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• pp.1095-1098
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• 1988

Congenital cystic adenomatoid malformation[CCAM] is a rare disease that cause respiratory distress in the newborn and infants, but is one of the two causes along with lobar emphysema. This malformation has the pathologic characteristics which can be differentiated from other forms of diffuse cystic disease, i.e. CCAM is marked proliferation of the terminal bronchioles and that can enlarge rapidly by air trapping in cystic areas. The CCAM has a clinical importance because of rapid worsening respiratory distress, with tachypnea, subcostal retraction and cyanosis. This is a strict surgical condition and after operation[lobar, segmental resection or pneumonectomy] the symptoms relieved obviously. We experienced 6 cases of CCAM from July, 1980 to September, 1987 at the Department of Cardiovascular and Thoracic Surgery, Severance Hospital, College of Medicine, Yonsei University. The male patients were two and female patients were four. The age distribution was from premature to 10 year old. One of them was 27 weeks gestational premature female who was borne dead. The other 5 patients were performed on thoractomy[1 case pneumonectomy and 5 cases lobectomy]. The postoperative courses were good and no complications were seen.

• Journal of Chest Surgery
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• v.27 no.11
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• pp.965-969
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• 1994

Infantile lobar emphysema is a pulmonary hyperinflation state that has the clinical features of an air block syndrome characterized by bronchial cartilaginous abnormalities or unknown origin. Left upper lobe was affected in most of the reported infantile lobar emphysema. Infantile lobar emphyema is divided into two categories. e.g., congenital and acquired. We have experienced a case of left lower lobe involved infantile lobar emphysema which had undergone left pneumonectomy. She had progressive signs of tension accompanied by mediastinal displacement, ventilatory and circulatory failure in infant period. Because of the combined left upper lobe hypoplasia, left pneumonectomy was performed. And there was no cartiliginous abnormality in pathologic finding. This is the first domestic case which was affected in the lower lobe and successful surgical repaired.

• Journal of Chest Surgery
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• v.11 no.3
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• pp.359-363
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• 1978

This is a case report of surgically treated esophageal traction diverticulum which was resulted from postpneumonectomy empyema. In March, 1976, left lower lobectomy and thoracoplasty were performed at a hospital to treat long standing lung abscess, after operation it developed into empyema. One year later [April, 1977], We did decortication and left upper lobectomy[ultimate pneumonectomy], which was followed by empyema again, 3 months later it developed esophagopleurocutaneous fistula. Esophagograms bowed an adult thumb tip sized traction diverticulum in the midportion of the esophagus. Finally in January, 1978, after 6 months of gastrostomy feeding, fistulectomy and diverticulectomy were performed The funnel shaped diverticulum was in midesophagus and retracted by surrounding inflammatory scar tissue. Now the postoperative course was uneventful.

• Journal of Chest Surgery
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• v.46 no.2
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• pp.153-155
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• 2013

A 57-year-old man was diagnosed with lung cancer and underwent pneumonectomy and mediastinal lymph node dissection. He was discharged without acute complications, but on a regular outpatient follow-up, he was readmitted with postpneumonectomy empyema. He was successfully treated with a vacuum-assisted closure device and for 1 year period of outpatient follow-up, there was no recurrence of empyema or lung cancer.

• Journal of Chest Surgery
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• v.49 no.2
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• pp.138-140
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• 2016

Broncho-pleural fistula (BPF) and esophago-pleural fistula (EPF) after pulmonary resection are challenging to manage. BPF is controlled by irrigation and sterilization, but such therapy is not sufficient to promote closure of EPF, which usually requires surgical management. However, it is generally difficult to select an appropriate surgical method for closure of BPF and EPF. Here, we report a case of concomitant BPF and EPF after left completion pneumonectomy, in which both fistulas were closed through a right thoracotomy.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.201-205
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• 1995

Most of the patient with endobronchial tuberculosis have some degree of bronchial stenosis. however, a part of bronchial stenosis need aggressive treatment for the patency because of severe symptoms. The self-expendable metallic stents provide palliative treatment for narrowed airways where surgical resection is inadvisable. We experienced a successful left wedge pneumonectomy on a 29-year-old woman with obstruction of left main bronchus due to complication of the bronchial stent. She had inserted self-expendable metallic stents on left main bronchus of the tuberculous bronchial stenosis two times. There was no specific postoperative complication.