Left Lung Torsion: Complication of Lobar Resection for an Early Stage Lung Adenocarcinoma

Abstract

Lobar torsion is a fatal but fortunately rare occurrence following lung resection. Early clinical signs and radiographic features may be nonspecific resulting in diagnostic delay. A high index of suspicion is vital for early diagnosis and intervention to avoid further parenchymal necrosis and deadly gangrene. We report a case of left lower lobe torsion in a 76-year-old female following elective upper lobectomy for underlying lung adenocarcinoma. Diagnosis was made following highly suggestive radiographic findings prompting bronchoscopy and revision thoracotomy. An emergency detorsion failed to restore lung viability and was followed by completion pneumonectomy. The patient recovered and was discharged on the seventh postoperative day.

Lobar torsion after thoracoscopic upper bilobectomy: report of a case

“…This case report shows that detorsion, even in the absence of necrosis, should be performed within a few hours following the onset of torsion and, according to some authors, we believe that if this phenomenon persists for more than a few hours, preservation of the involved pulmonary area may not lead to clinical improvement (2). Although many authors argue that surgical resection remains the best treatment in case of delayed intervention (1,5), this option isn't suitable in patients with not optimal cardiopulmonary exercise test for completion pneumonectomy.…”

“…Pulmonary torsion is a rare and life-threatening condition in which the twisting of a lung lobe or an entire lung on its bronchovascular pedicle can lead to pulmonary infarction with secondary gangrene if left untreated, due to obstruction of the bronchus and blood vessels (1,2). This rare event, seen mainly following pulmonary resection or other thoracic procedures with an incidence of 0.089-0.2%, can also occur spontaneously, with severe blunt chest trauma or in association with other conditions as diaphragmatic hernia and complicating pneumonia (3,4).…”

Commentary: Bilobar lung torsion—Time is parenchyma in race to treatment

“…Eight cases of LT detorsion without immediate resection have been reported. 7,[12][13][14][15][16] Four of 8 affected lobes were ultimately nonviable, with 3 requiring interval resection Lobar torsion is a rare but potentially catastrophic pathology requiring a high index of suspicion for prompt diagnosis and patient-specific therapy based on time to diagnosis and vascular compromise. and 1 patient suffering a fatal cerebral embolism postoperatively.…”

“…Eight cases of LT detorsion without immediate resection have been reported. 7 , 12 , 13 , 14 , 15 , 16 Four of 8 affected lobes were ultimately nonviable, with 3 requiring interval resection and 1 patient suffering a fatal cerebral embolism postoperatively. 9 , 11 , 13 Overall, lung salvage depends on preoperative arterial flow, viability of affected tissue, and time to reoperation.…”