Discussion
This radiograph demonstrates the expected postoperative appearance of a pleural tent following lung volume reduction surgery in the right upper lobe (note the visible staple line), though this can be done after upper lobectomies for any cause. The anatomy of upper lobectomies in particular is unfavorable for post-operative pleura-pleura apposition, increasing the risk for air leaks from the staple line. In this procedure, the visceral pleura is peeled from the chest wall and draped over the staple line. This promotes apposition and decreases the chance of an air leak. A chest tube is placed under the tent intraoperatively, as seen here, and will eventually be removed. The cavity will eventually fill with fluid, just like a pneumonectomy cavity.
There is marked emphysema in the left lung. Incidentally, this patient also has a small left effusion which is chronic and unrelated to the procedure.