Table of Contents Pneumonectomy signs Lobectomy signs Chest x-ray Indications Lung lesions workupTest yourselfSome relevant OSCE stations 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 scarOn affected side:Tracheal displacement to side of removalReduced expansionDull percussion noteAbsent breath sounds (although there may be bronchial breathing in the upper zone due to tracheal deviation) Lobectomy signs Left/right thoracotomy scarMay be no other signs due to compensatory hyperexpansion of the remaining lobesMay be some reduced expansion, dullness to percussion and reduced air entry 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 malignancyLocalised bronchiectasisAspergillomaLarge bullectomyTB (historically – practice discontinued) Lung lesions workup CT chest/abdomen/pelvis + PETConfirm no metastasisAttain histologyCT-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? Oops! This section is restricted to members. For patients with FEV1 below the cut off, which other scan may be appropriate to gain more information? Oops! This section is restricted to members. Some relevant OSCE stations Respiratory examPneumonectomy stationMore here!