Pneumonectomy / Lobectomy

A pneumonectomy is the removal of an entire lung, and a lobectomy is the removal of a lobe of the lung.

Pneumonectomy signs

• Left/right thoracotomy scar
• On affected side:
  • Tracheal displacement to side of removal
  • Reduced expansion
  • Dull percussion note
  • Absent breath sounds (although there may be bronchial breathing in the upper zone due to tracheal deviation)

Lobectomy signs

• Left/right thoracotomy scar
• May be no other signs due to compensatory hyperexpansion of the remaining lobes
• May be some reduced expansion, dullness to percussion and reduced air entry 

Chest x-ray

• Fluid fills cavity of removed lung (radio-opaque)
• Organs shift into cavity of removed lung (i.e. heart and trachea displaced)

Indications

• Lung malignancy
• Localised bronchiectasis
• Aspergilloma
• Large bullectomy
• TB (historically – practice discontinued)

Lung lesions workup

• CT chest/abdomen/pelvis + PET
  • Confirm no metastasis
• Attain histology
  • CT-guided biopsy/bronchoscopy/mediastinoscopy 
• Pulmonary function tests: to determine whether surgical resection is appropriate

Test yourself

What are the FEV1 cut offs for when pneumonectomy and lobectomy are appropriate?

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For patients with FEV1 below the cut off, which other scan may be appropriate to gain more information?

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Some relevant OSCE stations

1. Respiratory exam
2. Pneumonectomy station
3. More here!