Lung torsion

Lung torsion is a very rare situation typically described as an adverse event after a pneumonectomy. In extremely rare situations it can also occur after less invasive procedures such as video-assisted thoracic surgery (VATS) 11 or even spontaneously in the native lung.

 It has a reported incidence pf 0,09-0,4% 12.

It occurs when a lobe (or the complete lung) rotates around hilar structures. The degree of rotation is usually 180°, although on in some instances 90°or 360° torsion can occur.

The torsive lung creates a trifold compromise in airways, arterial blood supply and the venous-lymphatic drainage 13 due to lumen kinking.  The affected lobe often shows haemorrhagic infarction or necrosis.

Predisposing factors

Described predisposing factors include 7 :

  • presence of a pneumothorax and or pleural effusion
  • existence of a free and long vascular pedicle to the lung
  • existence of a non-ventilated lobe
Plain radiograph

On plain film, it can be suspected when a collapsed or consolidated lobe is seen in a an unusual position especially in the context of a recent pneumonectomy 4. The affected lobe is often opacified 5. Rapid opacification of the lung following trauma/surgery or marked change in position of opacified lobe on short interval serial radiographs or an unusual position of a collapsed lobe can aid to the diagnosis. Other radiographic findings include inappropriate hilar displacement and a reticular pattern from venous congestion.

CT

CT findings in postoperative lobar torsion include 

  • tapered obliteration of the proximal pulmonary artery and accompanying bronchus of the involved lobe
  • amorphous soft-tissue attenuation at the hilum. 
  • the torsive lobe can show 
  • the neofissure following lobectomy can show bulging and appear in an unusual orientation. 

A lung torsion is considered a medical emergency. The optimal therapeutic approach remains controversial 14.The decision for detorsion or lobectomy usually depends on the viability of the torsive lung which is better appreciated after open thoracotomy. Detorsion offers lung salvage but if inappropriate, it may lead to thoracotomy and lobectomy. 

Other early or late post lobectomy complications (pneumonia, vascular occlusion) with similar clinical presentation.

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Article Information

rID: 22342
System: Chest
Tag: cases
Synonyms or Alternate Spellings:
  • Pulmonary torsion
  • Torsion of the lung
  • Lung torsions
  • Lobar torsion - lung

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