Pneumonectomy-CXR

34 yrs  male for immigration shows uniform  opacity of left hemithorax with  possible staples near the hilum , crowding of ribs, tracheal deviation to left,  raised dome and heart shifted to left  with scoliotic curvature of  dorsal spine  consistent with history of  pneumonectomy status. Apparent lucency in the left hilar region is possibly sign of anterior mediastinal herniation of right lung (normal compensation in surgery) 

Teaching points by Dr MGK Murthy

1. Staples surround the abruptly terminated left main bronchus. Anterior mediastinal herniation of right lung across to left is identified. 

2.  Herniation of right lung to left is much more common than other way round (possibly because aorta being left sided structure prevents left lung from herniating to  azygo esophageal recess on right. Space in pneumonectomy on right  is mostly filled by heart 

3.  Anterior herniation is more common because heart rotates and occupied the posterolateral space on left in case  of ipsilateral  pneumonectomy. Rarely posterior herniation can occur above or below the azygos arch (azygoesophageal recesses ) 

4. Congenital absence makes the chest much smaller with crowded ribs more accentuated