Open Access Case report

Postpneumonectomy-like syndrome presenting in a patient with treated pulmonary tuberculosis: a case report

Jennifer C Kam13*, Javier Dieguez12, Vikram Doraiswamy13, Enis Alberaqdar12, Aparna Ramchandran13, Marc Adelman12, Alan J Klukowicz12 and Richard A Miller12

Author Affiliations

1 Seton Hall University School of Graduate Medical Education; St. Michael’s Medical Center, 111 Central Ave., Newark, NJ 07102, USA

2 Division of Pulmonary and Critical Care Medicine, St Michael’s Medical Center, Seton Hall University, Newark, NJ, USA

3 Department of Internal Medicine, St Michael’s Medical Center, Seton Hall University, Newark, NJ, USA

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Journal of Medical Case Reports 2013, 7:40  doi:10.1186/1752-1947-7-40

Published: 12 February 2013

Abstract

Introduction

Postpneumonectomy syndrome is a rare condition that is characterized by dyspnea resulting from an extreme mediastinal shift and bronchial compression of the residual lung following surgical pneumonectomy. It is even rarer for this syndrome to present in patients without a history of prior lung surgery but induced by autopneumonectomy due to parenchymal disease, an entity termed ‘postpneumonectomy-like syndrome’.

Case presentation

We present a rare case of a 91-year-old Puerto Rican man presenting with progressively worsening dyspnea with a history of pulmonary tuberculosis diagnosed 40 years earlier who developed severe unilateral lung fibrosis. Plain X-ray and computed tomography scans confirmed the presence of postpneumonectomy-like syndrome secondary to his parenchymal lung destruction. The patient developed cor pulmonale due to his extensive lung disease and as a consequence was not a suitable candidate for surgical intervention. The patient was otherwise stable until he developed acute respiratory distress from an acute upper gastrointestinal bleed and died four days into his hospital course.

Conclusion

We present a rare case of postpneumonectomy-like syndrome as sequelae of severe pulmonary parenchymal tuberculosis infection along with a review of literature, in the hopes of aiding clinicians to include the differential of postpneumonectomy-like syndrome in patients presenting with worsening dyspnea without a history of surgical lung resection.

Keywords:
Cor pulmonale; Dyspnea; Pneumonectomy; Postpneumonectomy-like syndrome; Postpneumonectomy syndrome; Pulmonary fibrosis; Tuberculosis