Pleuroperitoneal Shunt for Pneumonectomy Cavity Malignant Effusion

doi:10.1378/chest.96.3.686

Chest

Volume 96, Issue 3, September 1989, Pages 686-688

https://doi.org/10.1378/chest.96.3.686 Get rights and content

Delayed mediastinal shift toward the remaining lung is an unusual cause of postpneumonectomy dyspnea. We report a patient who developed severe dyspnea when a malignant effusion occurred in the pneumonectomy cavity and caused a contralateral mediastinal shift. Repeated thoracentesis was needed until insertion of a pleuroperitoneal shunt effected palliation.

Section snippets

CASE REPORT

A 60-year-old woman underwent right pneumonectomy for adenocarcinoma of the lung. Preoperative evaluation, including mediastinoscopy, revealed no evidence of metastatic disease. Three of eight peribronchial nodes, resected at the time of surgery, were found to contain adenocarcinoma. Her postoperative course was uneventful until four months after surgery when she developed left hip metastases. Local radiation therapy was performed with excellent palliation of pain. Six months after surgery she

DISCUSSION

The patient described herein had the unusual finding of a mediastinal shift toward the remaining lung that occurred several months after surgery. Rapid reaccumulation of a malignant effusion necessitated frequent thoracentesis of the pneumonectomy cavity until palliation was achieved by the placement of a pleuroperitoneal shunt. The usual postoperative findings that follow a pneumonectomy are well described.¹ At the time of surgery, care is taken to be certain that the remaining lung is well

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Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition)
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The etiology and incidence of respiratory complications from talc pleurodesis need further exploration. This is an alternative technique to manage malignant pleural effusions refractory to chemical pleurodesis.294–300 It may also benefit patients with trapped lung, particularly those with lungs trapped by visceral pleural carcinomatosis.300
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Palliation of symptoms and complications in lung cancer patients is possible, and physicians who provide such care must be knowledgeable about these issues.
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2003, Chest
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The majority of patients who acquire lung cancer will have troublesome symptoms at some time during the course of their disease. Some of the symptoms are common to many types of cancers, while others are more often encountered with lung cancer than other primary sites. The most common symptoms are pain, dyspnea, and cough. This document will address the management of these symptoms, and it will also address the palliation of specific problems that are commonly seen in lung cancer: metastases to the brain, spinal cord, and bones; hemoptysis; tracheoesophageal fistula; and obstruction of the superior vena cava.
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Pleuroperitoneal shunts were implanted in 17 patients with intractable pleural effusions, 15 of which were malignant and 2 benign. Complicating factors included 13 instances of severe trapped lung and 3 cases of synchronous ascites. There was one hospital death. Palliation of dyspnea at rest was achieved in all patients, although 3 required oxygen with exertion. Four shunts became occluded between 1 and 10 months after placement. Two of these were replaced. The remaining conduits continued to function to the present or until the patients' deaths between 1 and 28 months. Shunting allowed hospital discharge and provided symptomatic relief in a group of patients in whom other approaches had failed or were not applicable.
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Selected ReportsPleuroperitoneal Shunt for Pneumonectomy Cavity Malignant Effusion

Section snippets

CASE REPORT

DISCUSSION

Am J Med

J Thorac Cardiovasc Surg

Chest

J Thorac Cardiovasc Surg

Postoperative chest radiograph: 11. Alterations after major intrathoracic surgery

AJR

Selected Reports
Pleuroperitoneal Shunt for Pneumonectomy Cavity Malignant Effusion