Pulmonary Torsion Research Articles

Prevention of middle lobe torsion after right upper lobectomy with a polymeric sealant

Lobar torsion is a rare and potentially serious complication after pulmonary resection. A number of procedures have been described to prevent it. We report an easy and quick technique to avoid this complication after right upper lobectomy. Torsion of the lung represents a rotation of the hilar structures (bronchus, artery, and vein), with consequent vascular compromise and airway obstruction. Reported occurrence rates are between 0.1% and 0.3%. The degree of rotation is generally 180 , but 90 and 360 torsions have also been described. This complication occurs more frequently in the middle lobe after right upper lobectomy; however, torsion of even the entire lung has been reported after the resection of other lobes, chest surgery not involving pulmonary resection, or lung transplant. Mortalities from 12% to 16% has been reported for complicated torsions. Several methods of fixation of the remaining lobes have been described to prevent this dreadful complication.

Complicaciones quirúrgicas de la resección pulmonar

We review incidence, etiology, diagnosis, prevention and treatment of the following complications of pulmonary resection: prolonged air leak, subcutaneous emphysema, residual pleural spaces, early bronchial stump dehiscence, bleeding, pleural empyema, bronchopleural fistula, esophagopleural fistula, chylothorax, cardiac herniation, pulmonary torsion, postpneumonectomy syndrome, nerve injuries and tumor embolism.

Simple Prophylactic Fixation for Lung Torsion

Although pulmonary torsion is a rare complication after lung resection, thoracic surgeons should always consider the risk of this development. We describe a new prophylactic method to repair the residual lobe by using an absorptive sheet and fibrin glue. Between January 2009 and March 2010, 6 patients underwent this simple prophylactic fixation for lung torsion, and their clinical records were retrospectively reviewed. No postoperative complications were observed in this series. This technique is satisfactorily effective and does not result in any complications.

Torsión pulmonar como complicación de una lobectomía pulmonar, descripción de dos casos

We report 2 cases of pulmonary torsion discovered during the early postoperative recovery of patients who had undergone lobectomy. Early diagnosis, based on chest radiography and confirmed by computed tomography, meant we were able to avoid major surgical resection and the development of further complications. Pulmonary torsion is a rare but potentially serious abnormality. Prompt diagnosis is the key to preventing tissue injury and complications such as necrotizing pneumonitis, thromboembolic disease, or septic shock. Among the diagnostic tests that can be carried out if there is good reason to suspect torsion, we emphasize simple chest radiography and fiberoptic bronchoscopy, supported by computed tomography or arteriography, even though a firm diagnosis requires surgical exploration of the affected lung. Definitive treatments range from reversing the torsion and securing the lung to resecting the lung if the parenchymal tissue has been fully compromised.

Lobar torsion following thoraco‐abdominal oesophagogastrectomy

Following thoraco-abdominal oesophagogastrectomy for an adenocarcinoma of the lower oesophagus, an 81-year-old female with no pre-existing respiratory disease could not be weaned from mechanical ventilation. Right upper and middle lobe torsion were found at thoracotomy on the 14th postoperative day. Both lobes were resected. The patient was discharged from hospital after several postoperative complications. Pulmonary torsion is a rare, potentially life-threatening complication of thoraco-abdominal oesophagogastrectomy. Differentiation from the more common postoesophagectomy pulmonary complications can be difficult. Early post-thoracotomy lung opacification, in the absence of the expected degree of hypoxaemia, should trigger a suspicion of pulmonary torsion.

Spontaneous Middle Lobe Torsion Secondary to Pleural Effusion

Pulmonary torsion is very rare, and usually occurs following lung resection. We report a case of spontaneous middle lobe torsion in a patient presenting with a right pleural effusion. The condition was treated by lobectomy through a totally thoracoscopic approach.

Pulmonary torsion of the lingula following a segmentectomy of the left upper division

We report a case of pulmonary torsion of the lingula. Thoracoscopic segmentectomy of the left upper division was performed on a 67-year-old woman. The chest radiograph on the first postoperative day showed consolidation in the left apical area. By the second postoperative day, the consolidation had increased in size. Bronchoscopy and chest contrast-enhanced computed tomography (CT) were conducted, and she was diagnosed with torsion of the lingula. We performed an emergency operation and resected the affected lung because of a gangrenous lobe. Although pulmonary torsion is a rare complication following lung resection, thoracic surgeons should always consider the risk. To prevent pulmonary torsion, we should confirm the correct position of the remaining lobes, and fixation of the lobes should be performed if there is little or no parenchymal bridge between contiguous lobes. A high index of clinical suspicion is necessary for early diagnosis, and rethoracotomy should be performed without delay.

Necrotizing pneumonitis caused by postoperative pulmonary torsion

Pulmonary torsion is an adverse event with a reported incidence of 0.089-0.4%. It may occur spontaneously, after trauma but most often as a rare complication after pulmonary surgery. We describe a case of lobar torsion of the left upper lobe after lobectomy of the left lower lobe, which resulted in a necrotizing pneumonitis with fever, hemoptysis and weight loss. A completion pneumonectomy was performed after which the patient recovered well. A review of the literature shows that a delay in diagnosis and treatment of this rare complication can have catastrophic consequences. Surgery is the treatment of choice since sparing of the lobe is hardly ever possible due to the irreversible ischemic changes. Detorsion, instead of resection, may lead to fatal complications. Although infrequent, one should be aware of lobar torsion and the necessity for immediate re-intervention.

A RARE CAUSE OF ACUTE COR PULMONALE IN LUNG TRANSPLANTATION

INTRODUCTION:Pulmonary torsion is a rare cause of pulmonary infarction. There are approximately sixty cases described in the literature that were associated with pleural effusions, lobar atelectasis, tumor, or as a complication of pulmonary resection. It can also occur as result of lung transplantation.

Partial Pulmonary Torsion After Thoracotomy Without Pulmonary Resection

Partial Pulmonary Torsion After Thoracotomy Without Pulmonary Resection

Causes and Presenting Features of Pulmonary Infarctions in 43 Cases Identified by Surgical Lung Biopsy<xref rid="AFF1"><sup>*</sup></xref>

Although pulmonary infarction is usually associated with pulmonary thromboembolism, it can occur with other disorders such as vasculitis, angioinvasive infections, sickle-cell disease, tumor embolism, and pulmonary torsion. To identify causes and presenting features of pulmonary infarctions diagnosed by surgical biopsy in a consecutive series of patients encountered at a single institution. Retrospective review. Tertiary care, referral medical center. Forty-three patients with pulmonary infarction identified on surgical lung biopsy over a period of 7 years, January 1996 through December 2002. The median age of these 43 patients was 55 years (range, 22 to 85 years); 17 patients (40%) were women, and 26 patients (60%) were men. Thirty-five patients (81%) had a smoking history. Twenty-eight patients (65%) presented with solitary or multiple lung nodules/masses of undetermined etiology. The underlying cause was identifiable in 31 cases (72%) based on a review of clinical, laboratory, radiologic, and histopathologic data. The two most common causes were pulmonary thromboembolism (18 cases, 42%) and pulmonary infections (5 cases, 12%). Thromboembolic pulmonary infarctions typically presented as solitary or multiple nodules located in the subpleural regions. Other causes included diffuse alveolar damage in two cases (5%), pulmonary torsion in two cases (5%), and one case each of lung cancer, amyloidosis, embolotherapy, and catheter embolism. In 12 cases (28%), the underlying cause was not directly identifiable but was probably due to previous pulmonary thromboembolism. We conclude that although pulmonary thromboembolism is the most common cause of pulmonary infarction identified by surgical lung biopsy, a variety of other causes are clinically encountered, including infections, inflammatory or infiltrative lung diseases, pulmonary torsion, malignancy, and nonthrombotic embolism. Pulmonary infarction should be considered in the differential diagnosis of peripheral lung nodules or masses.

Causes and Presenting Features of Pulmonary Infarctions in 43 Cases Identified by Surgical Lung Biopsy

Although pulmonary infarction is usually associated with pulmonary thromboembolism, it can occur with other disorders such as vasculitis, angioinvasive infections, sickle-cell disease, tumor embolism, and pulmonary torsion.To identify causes and presenting features of pulmonary infarctions diagnosed by surgical biopsy in a consecutive series of patients encountered at a single institution.Retrospective review.Tertiary care, referral medical center.Forty-three patients with pulmonary infarction identified on surgical lung biopsy over a period of 7 years, January 1996 through December 2002.The median age of these 43 patients was 55 years (range, 22 to 85 years); 17 patients (40%) were women, and 26 patients (60%) were men. Thirty-five patients (81%) had a smoking history. Twenty-eight patients (65%) presented with solitary or multiple lung nodules/masses of undetermined etiology. The underlying cause was identifiable in 31 cases (72%) based on a review of clinical, laboratory, radiologic, and histopathologic data. The two most common causes were pulmonary thromboembolism (18 cases, 42%) and pulmonary infections (5 cases, 12%). Thromboembolic pulmonary infarctions typically presented as solitary or multiple nodules located in the subpleural regions. Other causes included diffuse alveolar damage in two cases (5%), pulmonary torsion in two cases (5%), and one case each of lung cancer, amyloidosis, embolotherapy, and catheter embolism. In 12 cases (28%), the underlying cause was not directly identifiable but was probably due to previous pulmonary thromboembolism.We conclude that although pulmonary thromboembolism is the most common cause of pulmonary infarction identified by surgical lung biopsy, a variety of other causes are clinically encountered, including infections, inflammatory or infiltrative lung diseases, pulmonary torsion, malignancy, and nonthrombotic embolism. Pulmonary infarction should be considered in the differential diagnosis of peripheral lung nodules or masses.

Spontaneous pulmonary torsion secondary to pseudo-Meigs' syndrome

We present a case of pulmonary lobar torsion secondary to pseudo-Meigs syndrome. A 45-year-old woman with colonic cancer and metastatic ovarian cancer was suffering from dyspnea. CT scan showed massive pleural effusion, air trapping and twisted bronchus of the middle lobe. At thoracotomy, the middle lobe was torqued at 180 degrees around its bronchovascular pedicle in a counterclockwise direction. The infarcted middle lobe was resected. The pleural effusion had never recurred after resection of the metastatic ovary. This is the first report of spontaneous pulmonary torsion caused by massive pleural effusion secondary to pseudo-Meigs syndrome.

Pulmonary torsion after cardiac surgery in two infants: Review of pediatric literature

Torsion of a lung or a lobe (LT) is a severe, sometimes life-threatening event that may occur spontaneously, after trauma, or after cardiac or thoracic surgery. The authors report on 2 prematurely born neonates who had LT after cardiac surgery. Both patients successfully underwent pulmonary lobectomy, which seems to be the best surgical approach. Given that careful anatomic unfolding of the lung and its reinflation under vision at the end of a cardiac or thoracic operation is deemed crucial to avoid LT, the authors suggest that, in case of a complete pulmonary fissure and/or free long bronchovascular pedicle, lobe fixation should be accomplished, too. Because of its rarity, we could find only 6 well-documented reports of LT diagnosed in children, whereas another 3 cases were quoted without clinical details. The pediatric literature is reviewed.

Advantages of Diagnostic Nuclear Medicine

Advances in nuclear medicine have improved the detection and localization of very small abnormalities. Radionuclide imaging of myocardial perfusion is very useful for detecting coronary artery disease in patients who have an ambiguous presentation, such as those with chest pain syndrome and a nondiagnostic exercise test. Scintigraphy is also useful for diagnosing pulmonary thromboembolism, hyperthyroidism, testicular torsion, and fevers of unknown origin. In addition, improvements in positron-emission tomography and imaging with isotope-labeled monoclonal antibodies now permit detection and staging of prostate and brain malignancies and diagnosis of infections such as osteomyelitis.

Whole Lung Torsion after a Thoracoabdominal Esophagogastrectomy

ALTHOUGH torsion of a lobe is not uncommon during lung surgery, torsion of the whole lung during a nonpulmonary procedure is rare. Torsion of the lung is defined as the parenchymal rotation of the whole lung on its bronchovascular pedicle.' Rotation occurs with equal frequency in the left and right lungs. 2 Predisposing factors include transection of the inferior pulmonary ligament, pleural space adhesions, pneumothorax, and pleural effusion. 2 Pulmonary torsion is most often a consequence of trauma or a complication of thoracotomy. Oddi et al. 3 and Chan et al. 4 reported cases of torsion after a transthoracic esophageal surgery. We report a third such case of intraoperative torsion of the left lung during an esophagogastrectomy.

Massive cerebral infarction after completion pneumonectomy for pulmonary torsion.

A case of lower lobe torsion after left upper lobectomy is reported which was complicated by a cerebral infarction after completion pneumonectomy. Results of a small survey in Flanders revealed two additional cases of pulmonary torsion after lobectomy.

Pulmonary torsion: a questionnaire survey and a survey of the literature.

Pulmonary torsion is a rare but life-threatening complication of thoracic operations and trauma. A questionnaire was sent to 140 thoracic surgeons in the United Kingdom to examine its incidence, particularly torsion of the middle lobe after right upper lobectomy. The answers from 117 thoracic surgeons (84%) were collected and analyzed. Thirty-five responders (30%) had seen one or more cases of pulmonary torsion. The majority of cases occurred after pulmonary resection, and most of these instances involved middle lobe torsion after right upper lobectomy. In total, 39 cases were reported; 1 (3%) occurred spontaneously in an azygos lobe, 2 (5%) were seen after trauma, 28 (72%) were seen after pulmonary resections and 8 (21%), after other procedures. In this group of responders, 27 (77%) routinely fix the middle lobe to the remaining lobe after right upper or lower lobectomy, upper lobe fixation being required only if the transverse fissure is well developed. Of the 82 responders who had never seen instances of pulmonary torsion, only 47 (57%) routinely do this fixation.