Lobectomy/Pneumonectomy

Physical Examination

• General examination:

  • Surgical scar: Presence of a well-healed or healing scar from the lobectomy or pneumonectomy.

  • Reduced muscle mass: Decreased muscle mass on the side of the surgery, potentially due to disuse or nerve damage.

  • Tracheal deviation: A shift of the trachea towards the side of surgery, indicating lung volume loss.

• Chest inspection:

  • Asymmetry: Uneven chest expansion or volume loss on the side of surgery, suggesting post-surgical changes.

  • Reduced movement on the operated side, indicating lung tissue removal.

• Palpation:

  • Decreased expansion on the side of surgery, consistent with lobectomy or pneumonectomy.

  • Tactile fremitus: Decreased or absent vibration felt on the chest wall

• Percussion:

  • Dullness or flatness: Flat or dull sound upon chest percussion on the operated side, indicating the absence of lung tissue after surgery.

• Auscultation:

  • Decreased breath sounds: Diminished or absent breath sounds on the side of surgery, consistent with the removal of lung tissue.

  • Pleural rub: A grating sound heard during auscultation over the surgical site, potentially indicating post-surgical pleural inflammation.

  • Reduced vocal resonance

Look for underlying cause:

• Lung cancer:

  • Cachexia: Generalized muscle wasting and weight loss.

  • Clubbing: Abnormal enlargement of fingertips.

• Chronic obstructive pulmonary disease (COPD):

  • Barrel-shaped chest: Increased anteroposterior diameter due to air trapping.

  • Pursed-lip breathing: Breathing technique to promote better oxygenation and exhalation.

  • Use of accessory muscles: Increased use of neck and shoulder muscles during breathing.

  • Wheezing: Continuous, high-pitched whistling sound due to narrowed airways.

  • Hyperresonance on percussion: Unusually loud and low-pitched sound, indicating air trapping.

• Tuberculosis:

  • Cachexia: Generalized muscle wasting and weight loss.

• Lung abscess:

  • Fever: Elevated body temperature due to infection.

  • Foul-smelling sputum: Indicative of infection and lung abscess.

• Bronchiectasis:

  • Clubbing: Abnormal enlargement of fingertips.

  • Chronic productive cough: Persistent cough with sputum production.

  • Crackles: Discontinuous, short, high-pitched sounds due to inflammation or infection.

Differentials for a Thoracotomy Scar

• Lobectomy

• Pneumonectomy

• Single lung transplant

• Segmentectomy or wedge resection

• Open lung biopsy

• Decortication

• Lung volume reduction surgery

• Bullectomy

• Esophagectomy

• Repair of congenital diaphragmatic hernia

• Repair of traumatic diaphragmatic injury

• Thoracic aortic aneurysm repair

Causes of lobectomy/pneumonectomy

• Lung cancer

• Tuberculosis

• Fungal infections

• Lung abscess

• Benign lung tumours

• Bronchiectasis

• Emphysema or chronic obstructive pulmonary disease (COPD)

• Traumatic lung injury