Right Lower Lobe Bronchus Research Articles

RIGHT MIDDLE LOBE TORSION IN THE SETTING OF ABERRANT BRONCHIAL ANATOMY

SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary torsion (PT) is defined as twisting of the entire lung or lobe around its bronchovascular pedicle. This disorder most commonly involves the right middle lobe (RML) following right upper lobe (RUL) lobectomy. The objective of this report is to describe a case of RML torsion following RUL lobectomy, in the setting of aberrant bronchial anatomy, which potentially led to this problem. CASE PRESENTATION: A 61-year-old African American woman with a RUL nodule, suspected to be cancerous, presented for RUL lobectomy. Flexible bronchoscopy revealed a right mainstem bronchus (RMB), which ended in a trifurcation of the upper, middle, and lower lobe bronchi. During thoracotomy, the inferior pulmonary ligament (IPL) was divided and RUL lobectomy was completed. Her major and minor fissures were noted to be partially complete and she had a short pedicle to the RML. As her risk of developing RML torsion was deemed to be low, no prophylactic fixation was done. Pathology confirmed the nodule to be a T1a N0M0 stage I adenocarcinoma. Post-operatively she complained of chest pain and hemoptysis. CT scan of the chest showed opacification of the right upper hemithorax, and RML torsion was suspected. Subsequent bronchoscopy showed that the RML bronchi were extrinsically compressed. Thoracoscopy demonstrated that the RML was torsed and engorged with venous blood (Figure 1). A thoracotomy and RML lobectomy were performed. Final pathology showed ischemic necrosis and hemorrhage. DISCUSSION: Ordinarily, the RMB gives rise to the RUL bronchus and the bronchus intermedius, which then bifurcates into the RML and right lower lobe (RLL) bronchi. The bronchus intermedius was absent in this patient and, instead, the RMB ended in a trifurcation of the RUL, RML, and RLL bronchi. The risk of RML torsion increases with division of the IPL in patients with complete pulmonary fissures and a lack of parenchymal bridges between the lobes prior to surgery. These factors increase the mobility of the RML, while the presence of a long pedicle predisposes to additional rotation along the bronchovascular pedicle.(1-3) This patient, despite lacking these risk factors, still developed RML torsion after RUL lobectomy. We speculate that the aberrantly located RUL takeoff, once resected, increased the range of rotational motion of the RML relative to the RLL, resulting in torsion of the RML. CONCLUSIONS: In patients at risk for RML torsion after RUL lobectomy, incomplete severing of the IPL and prophylactic inter-lobar fixation (or fixation to the thoracic wall or cardiac fat pad) are suggested. (2,3) Such measures may need to be considered in patients with a trifurcate RMB. Reference #1: Felson B. Lung torsion: Radiographic findings in 9 cases. Thoracic Radiology 1987 March; 162(3): 631-8. Reference #2: Moser E, Proto A. Lung torsion: Case report and literature review. Thoracic Radiology 1987 March; 162(3): 639-43. Reference #3: Kanemitsu S, Tenaka K, Suzuki H et al. Pulmonary torsion following right upper lobectomy. Ann Thorac Cardiovasc Surg 2006; 12: 417-9. DISCLOSURES: No relevant relationships by Batool Abuhalimeh, source=Web Response No relevant relationships by Joseph Lahorra, source=Web Response No relevant relationships by Tanya Marshall, source=Web Response No relevant relationships by Sanjiv Tewari, source=Web Response

Time analysis of pulmonary reexpansion after the acute foreign body airway obstruction removal in miniature pigs

Objective To investigate the time of spontaneous recovery of atelectasis after removing the acute airway foreign bodies in miniature pigs. Methods Twenty-two miniature pigs were inserted into the occlusion stent in the right lower lobe bronchus by using bronchoscopy. After confirming the formation of atelectasis, the occlusion stent was removed and the imaging changes were observed for 3 weeks continuously. Results Atelectasis was formed within 1 week after the airway occlusion stent implantation in miniature pigs. Pulmonary reexpansion was observed obviously on week 3 after removal of airway occlusion stent (P<0.05). Conclusions The spontaneous recovery time of atelectasis, which caused by an acute foreign body airway obstruction within 1 week, may take 3 weeks at least. Key words: Tracheal diseases/SU; Foreign bodies/SU; Stents/AE; Atelectasis/ET/RA/PP

Clinical analysis of bronchial foreign bodies in 246 children

To analyze the characters of bronchial foreign bodies in children and the utilization of bronchoscope in the treatment of bronchial foreign bodies. A total of 246 children were diagnosed with bronchial foreign bodies at our hospital during January 2000 until August 2009. Under local mucosal anesthesia, a bronchoscope was inserted through nasal cavity into bronchi. After identifying the site of foreign body, grasping forceps was guided through bronchoscope to remove the foreign body from airway. Among 246 cases, hard nut and skin of melon seed were found (n = 230, 93.5%). The most common site of foreign body was in right lower lobe bronchi (n = 98, 38.9%). The average operative frequency was 1.9 +/- 1.3 and one-time extraction ratio 58.5% (n = 144). The one-time extraction ratio of patients with foreign body obstructed in main bronchi (91.1%), right middle lobe (60.0%) and right lower lobe (55.1%) was higher than others. The operation frequency of using basket grasping forceps (1.4 +/- 0.9) was lower than those using tooth type forceps (2.1 +/- 1.4). And the difference was significant (P = 0.000). For bronchial foreign body in pediatric patients, hard nut and skin of melon seed are the most common foreign bodies. The right and left lower lobe bronchi are the predilection site. Foreign body in main bronchus is the easiest to be removed by grasping forceps. For massive foreign bodies, basket grasping forceps fares better than tooth grasping forceps.