Reversible compression of the left lower lobe vein after right pneumonectomy

Abstract

Herein we report the case of a 60-year-old female patient who developed severe respiratory failure after right-sided pneumonectomy starting 2 hours after uneventful surgery. A computed tomographic scan revealed a completely congested left lower lobe. The underlying pathomechanism of this unique finding was a kinking effect of the left lower lobe vein over the descending aorta, caused by the shifting of the heart toward the right side. Even with immediate reintubation and aggressive ventilation it was impossible to stabilize the patient and therefore an extracorporal membrane oxygenation (ECMO) had to be implanted. The ECMO support and right-lateral and prone positioning of the patient markedly improved oxygenation. After a stabilization period of 2 days the ECMO could be removed and the patient was extubated on the ninth postoperative day. To the best of our knowledge, this is the first reported case of a unilobar edema caused by a transiently impaired venous drainage after pneumonectomy. The combination of immediate ECMO support together with right-lateral and prone positioning resulted in restoration and stabilization of the patient's cardiorespiratory function.