Pneumonectomy / Lobectomy

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/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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