Tensioned space after pneumonectomy for cancer with mediastinal shift and cardiac tamponade‑causes and treatment (Review)

Motas,Natalia; Manolache,Veronica; Rus,Ovidiu; Davidescu,Mihnea; Cioalca‑iliescu,Madalina Cristiana; Socea,Bogdan; Ceausu,Mihail Constantin; Trifanescu,Oana Gabriela

doi:10.3892/etm.2022.11485

Tensioned space after pneumonectomy for cancer with mediastinal shift and cardiac tamponade‑causes and treatment (Review)

Authors:
- Natalia Motas
- Veronica Manolache
- Ovidiu Rus
- Mihnea Davidescu
- Madalina Cristiana Cioalca‑iliescu
- Bogdan Socea
- Mihail Constantin Ceausu
- Oana Gabriela Trifanescu
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Affiliations: Clinic of Thoracic Surgery, Institute of Oncology ‘Prof. Dr. Al. Trestioreanu’, Bucharest RO‑022328, Romania, Clinic of Thoracic Surgery ‘Prof. Dr. Al. Trestioreanu’, University of Medicine and Pharmacy Carol Davila, Bucharest RO‑020021, Romania, Clinic of General Surgery, Emergency Clinical Hospital Sf. Pantelimon, Bucharest RO‑021659, Romania, Department of Pathology, Institute of Oncology ‘Prof. Dr. Al. Trestioreanu’, Bucharest RO‑022328, Romania, Clinic of Oncology, Institute of Oncology ‘Prof. Dr. Al. Trestioreanu’, Bucharest RO‑022328, Romania
Published online on: July 1, 2022 https://doi.org/10.3892/etm.2022.11485
Article Number: 548
Copyright: © Motas et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Regarding the pleural space after pneumonectomy for malignancy, a vast number of studies have assessed early drop in the fluid level, suggesting a broncho‑pleural fistula, but only a small number of studies reported on the abnormal increase in the fluid level‑a potentially lethal complication. In the present study, the available databases worldwide were screened and 19 cases were retrieved, including 14 chylothorax and 3 hydrothorax cases, 1 pneumothorax and 1 haemothorax case. Tension chylothorax is caused by mediastinal lymph node dissection as an assumed risk in radical cancer surgery. For tensioned haemothorax, the cause has not been elucidated, although lymphatic stasis associated with deep venous thrombosis was suspected. Tensioned pneumothorax was caused by chest wall damage after extrapleural pneumonectomy combined with low aspiration pressure on the chest drain. No cause was determined for none of the tensioned hydrothorax‑all 3 cases had the scenario of pericardial resection in addition to pneumonectomy in common. Tensioned space after pneumonectomy for cancer manifests as cardiac tamponade. Initial management is emergent decompression of the heart and mediastinum. Final management depends on the fluid type (chyle, transudate, air, blood) and the medical context of each case. Of the 19 cases, 12 required a major surgical procedure as the definitive management.

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