Case of spontaneous whole-lung torsion with literature review

A Patient with Lung Adenocarcinoma Accompanied by Whole Right Lung Torsion Induced by the Accumulation of a Large Amount of Pleural Effusion

“…Among lung torsion cases, whole lung torsion is rare, and its prognosis is poor (1). To our knowledge, of 27 case reports in English regarding spontaneous lung torsion, 9 including our own case were spontaneous whole lung torsion (Table) (4)(5)(6)(7)(8)(9)(10)(11)(12). Six of these cases were malignant tumor, and pleural effusion was noted in all cases.…”

“…The cause of lung torsion is classified into three types: thoracic surgery, traumatic, and spontaneous development ( 2 ). Regarding spontaneous development, lung torsion accompanying the following events has been reported: atelectasis, pleural effusion, spontaneous pneumothorax, thoracocentesis, lung biopsy-induced pneumothorax, lung collapse, congenital defect of the pulmonary ligament, diaphragmatic hernia, obstruction by tumor, pneumonia, completely separated oblique fissure of the lung, and long bronchial pedicle ( 1 , 2 , 4 , 5 ). The main physical findings include dyspnea, a fever, chest pain, and cough, but asymptomatic cases as in the present patient have been reported ( 1 ).…”

“…Since bronchial and lung arteriovenous torsion causes airway obstruction, venous perfusion disorder, ischemia, infarction, and necrosis and the mortality is high, rapid surgical therapeutic intervention is necessary. The best procedure to release torsion is determined based on the lung parenchymal invasiveness, and when hemorrhagic infarction and necrosis have occurred, lung resection is recommended because the risk of reperfusion injury is high ( 1 , 4 , 6 , 7 ).…”

Spontaneous bilobar torsion managed with pneumopexy

“… 6 , 7 , 8 , 9 , 10 Bronchoscopy is diagnostic and may reveal an obstructed or distorted bronchial lumen, and vascular compromise progresses from ischemia to gangrene. 11 , 12 , 13 , 14 Urgent intervention is required and includes detorsion and fixation or resection of nonviable tissue. 11 , 15 , 16 , 17 Whole lung and isolated lobar torsion has been previously described.…”

Commentary: When spontaneous means threatening. The importance of thinking differently to prevent an unexpected, severe event

“…Ohde and colleagues 9 wrote that approximately 10 cases of spontaneous pulmonary torsion have been reported in literature to date, and a few other experiences were added later. 10 , 11 So, the frequency of these spontaneous event is difficult to assess. A prompt diagnosis is extremely important for conservative management, allowing a surgical lung-sparing procedure before the parenchyma is compromised by gangrene or ischemia.…”