One’s learning is never complete: chronic high-pressure life-treating pleural effusion in post-pneumonectomy patients

Post-pneumonectomy syndromes are a series of rare postoperative complications observed as potential consequence after pneumonectomy. In its most frequent presentation, it is usually caused by mediastinal structures rotation and displacement towards the operated side, resulting in organs compression. We describe a case of reverse mediastinal shift, occurred 25 years after an emergency left pneumonectomy due to a motorcycle accident. Unlike what usually happens, the cavity left empty after the operation did not reduce considerably, but we observed an abnormal pleural effusion accumulation up to the displacement of distal trachea and compression of the residual pulmonary artery until its almost complete occlusion. To avoid this potentially deadly complication we placed a pleural drainage in order to prevent cardiopulmonary arrest and reduce symptoms. The “reverse post-pneumonectomy syndrome” can be counted in the spectrum of post-pneumonectomy syndromes and it should be considered in patients with a history of pneumonectomy, which develop dyspnoea, cough or asthenia long after pneumonectomy.