CTICasesPost-Pneumonectomy Mediastinal Rotation (Buffalo Chest)
Imaging findings
An ICU radiograph shows a clear right lung and an opaque left lung with surgical clips and leftward mediastinal shift in a patient with prior left pneumonectomy. CT shows the left lung completely absent with no residual pneumonectomy cavity, and the right lung extending across the midline into the left chest.
Key takeaways
After pneumonectomy, the mediastinum rotates about the relatively fixed descending aorta, dragging the anterior junction line and heart into the empty hemithorax so the remaining lung extends across midline. This is mediastinal rotation, not true lung herniation, since no anatomic barrier is breached, and complete resolution of the pneumonectomy space (rather than a residual fluid-filled cavity) is more typical after childhood pneumonectomy.
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