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Post-pneumonectomy Complications — SCE Medical Oncology MCQ

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HardLung CancerPost-pneumonectomy ComplicationsSCE Medical Oncology

On day 3 after right pneumonectomy, a patient develops rapidly worsening hypoxaemia. Chest radiography shows diffuse alveolar shadowing throughout the remaining left lung; echocardiography shows preserved left-ventricular function and there is no focal airway leak. What complication is most likely?

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Correct answer: D — Post-pneumonectomy pulmonary oedema from permeability injury

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · B = shown as D · A = shown as E

B is correct. Post-pneumonectomy pulmonary oedema usually occurs in the first few postoperative days and affects the remaining lung, with right pneumonectomy and positive fluid balance recognised risk factors. It behaves as severe permeability injury or ARDS rather than left-heart failure. Bronchopleural fistula more often produces a new air-fluid level, persistent air leak, subcutaneous emphysema or aspiration; chylothorax causes pleural fluid rather than diffuse alveolar shadowing; and tumour recurrence cannot explain this acute day-3 syndrome. Treatment is supportive critical care with lung-protective ventilation and judicious fluid strategy.

Reference: Thorax post-pneumonectomy pulmonary oedema study: https://pubmed.ncbi.nlm.nih.gov/3406920/