Lung torsion

Case contributed by Dr Ashley Thorpe

Presentation

Shortness of breath and fever. Initially treated for pneumonia. Followed 5 days later by sudden right sided pleuritic chest pain and increased shortness of breath.

Patient Data

Age: 70 years
Gender: Male
X-ray

The admission chest radiograph shows dense consolidation affecting the right upper lobe.

A follow up radiograph at 5 days after presentation showed unexpected new consolidation within the right lower zone with resolution of the changes in the right upper zone.

CT

Follow up CT shows a 90 clockwise rotation of the right oblique fissure and a primarily posterior position of the right upper lobe.

Reformatted images reveals twisting of the lobar bronchial anatomy with up-going middle and lower lobe bronchi.

Volume rendering shows the right oblique fissure clearly visible on the anterior surface.

Case Discussion

The patient initially presented with signs and symptoms of a pneumonia with corresponding dense right upper lobe consolidation on chest X-Ray.

Five days later following antibiotic treatment he complained of sudden onset right sided pleuritic chest pain and a worsening of his shortness of breath.

CT revealed the right lung had torted causing potential threefold compromise of his airways, pulmonary arteries and veins. He was taken to a local cardiothoracic unit where the diagnosis was confirmed and underwent right upper and middle lobectomies.

Lung torsion is a very rare event and is almost invariably associated with a history of previous surgery. In this case it is theorized that an odd rotational force during coughing began a clockwise rotation of the right lung which was amplified by the density of the lobar consolidation.

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Case information

rID: 63043
Published: 1st Oct 2018
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Included
Excluded from licensing
Institution: Gloucestershire Hospitals NHS Foundation Trust

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