PMC10363897_01
Preoperative CT scan noting significant compression of the right atrium and ventricle. Complete obliteration of the right intra-thoracic cavity can be noticed with the liver displaced into the apex of the thoracic cavity. The left main bronchus appears patent without signs of compression or stretching.
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A computerized tomography (CT) scan of his chest revealed an elevated right hemidiaphragm and displacement of abdominal contents into the chest cavity with right atrium and ventricular compression (Figure 1).
(a) 750 cc mentor saline implant inserted through a right sided thoracotomy. (b) Mentor smooth round moderate plus profile saline implant.
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The chest was filled with water for volume estimation and it was approximately 850 mL, so a 750 mL Mentor  Smooth Round Moderate Plus Profile saline implant with diaphragm valve, style 2000, lot #7730370, was placed by plastic surgery after irrigation with dilute betadine (Figure 2).
Post operative chest X-ray showing corrected mediastinum positioning and improvement of the herniation from the left lung on the mediastinal structures.
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The patient was then transferred to the postanesthesia care unit and the postoperative chest X-ray showed a tissue expander in the right chest cavity with no other significant findings (Figure 3).
One month post operative CT scan showing right atrium and ventricle free of compression. Trachea, left main bronchus and esophagus in the normal anatomical position without evidence of patent without compression or malrotation.
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At 1 month postoperative clinic follow-up, the patient reported resolution of his tachycardia and dyspnea and one-month postoperative CT scan revealed that the expander was well positioned and the mediastinum had returned to the appropriate position with relief of the previously documented cardiac compression (Figure 4).