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Pneumonectomy / Lobectomy
Pneumonectomy signs


Left/right thoracotomy scar
On affected side
o Tracheal displacement to side of removal
o Reduced expansion
o Dull percussion note
o No breath sounds (although there may be bronchial breathing in the upper zone due to tracheal deviation
Lobectomy signs
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
Left/right thoracotomy scar
Usually no other signs
Chest X-Ray
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
Fluid fills cavity of removed lung (radio-opaque)
Organs shift into cavity of removed lung (i.e. heart and trachea displaced)
Indications
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
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Lung malignancy
Old TB
Localised bronchiectasis
Aspergilloma
Large bullectomy
Lung lesion workup
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
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CT chest/abdo/pelvis + PET
o Confirm no metastasis
Attain histology
o CT-guided biopsy/bronchoscopy/mediastinoscopy
Pulmonary function tests
o FEV1 > 2L = operate
o FEV1 < 2L = ventilation perfusion scanning to determine split lung function
© 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision