Torsion of a Lung Lobe: Diagnosis and Treatment

Abstract

Intraoperative lobar torsion occurred in 4 of about 2000 patients subjected to thoracotomy. Two of the patients died. Early diagnosis and proper management are of great importance to the outcome. Temporary deflation of the diseased lung by using double lumen endobronchial tube is a potential risk. Early progressive lobar opacity without signs of atelectasis on conventional chest radiograph is indicative of this serious complication. Computerized tomography and bronchoscopy are of diagnostic value. Exploratory thoracotomy must be performed without delay. The injured parenchyma should be sacrificed unless the diagnosis is obtained very early. When the injured lobe or lung is rotated back into normal position the airways may be flooded with serosanguinous fluid which promptly has to be removed. If an attempt is made to save the lobe or the lung, tracheostomy for frequent suction of the airways is indicated in order to prevent "spill-over" and dangerous postoperative hypoxia.

Evaluation of lung lobe torsion in Pugs: 7 cases (1991–2004)

“…[4][5][6][7][8] A definitive diagnosis of LLT can only be made via direct visual inspection by use of thoracoscopy or thoracotomy or at necropsy. 10 Breed-specific conformation may be a risk factor for LLT in dogs. Reduction of the torsion and attempts to preserve the lobe are not recommended because of the risk for reperfusion injury and initiation of the inflammatory cascade.…”

Lobar torsion after lung transplantation

“…8 Symptoms such as fever, hemoptysis, chest pain, and hypoxia are nonspecific and may mimic the characteristics of obstructive pneumonia. 6,7 Reconstructive CT can clearly demonstrate loss of enhancement in the involving vessels and abrupt cut-off of the involved bronchus, which may highly imply the phenomenon of vessels or bronchus torsion (Fig. 1E).…”

Postsurgical lobar torsion in an unusual setting

“…1,2 It is considered that complete deflation of the lung with a double-lumen tube makes torsion possible. 3,4 Other reported causes of lobar torsion include trauma, pneumonia, and most commonly atelectasis with an underlying etiology such as spontaneous or iatrogenic pneumothorax, massive pleural effusion, or airway obstruction. 5 In our case, the residual lobes were in the proper position at the end of the right upper lobectomy.…”

“…To avoid this complication, the residual lobe should be fixed, as is widely recommended. 1,4 In addition, suction should be applied to the chest tube for long enough to keep the lung inflated after long-term compression.…”