Correct!
5. Any of the above
The patient has known lung disease and something should be done to ensure that he has adequate pulmonary function after lung removal. Although this is a clinical decision, there are several algorithms which are recognized to assist with this decision (3). One of the simplest is to have the patient walk 2-3 flights of stairs. If the patient is able to do this without stopping, he or she probably has adequate lung function to tolerate a pneumonectomy. Another simple test is to perform spirometry. Those patients with an FEV1 > 2L are suitable for pneumonectomy or an FEV1 > 1.5 L are suitable for lobectomy. Another algorithm uses a radionucleotide perfusion lung scan where the FEV1 is multiplied by the percent perfusion of the lobes that will not be removed. If the predicted post-operative FEV1 is over 1 L, this is generally thought to be adequate. Still others use the diffusing capacity where a post-operative predicted DLCO of >60% is considered acceptable. Lastly, some use exercise pulmonary function testing where a VO2 max of > 20 ml/kg/min is considered adequate.
Our patient had an FEV1 of 2.2 L. Although a right lower lobe and right middle lobe lobectomies were planned, he underwent pneumonectomy secondary to technical surgical reasons that made a pneumonectomy preferable. His post-operative chest x-ray is shown in Figure 3.
Figure 3. Post-operative AP of chest.
Which of the following are true regarding post-operative pneumonectomy chest x-rays? (Click on the correct answer to proceed to the sixth and final page)