Table of Contents
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/mediastinoscopyÂ
- 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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