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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 
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Thoracotomy scar

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!
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