Recognizing and Managing Post-Lobectomy Lung Torsion: A Critical Case Report.

Abstract

BACKGROUND Lung torsion is very rare but is a recognized postoperative complication of lobectomy of the lung. This report describes the case of a 63-year-old woman with lung torsion of the left lower lobe following left upper lobe resection for lung neoplasms who required an emergency completion pneumonectomy. CASE REPORT The patient was a 63-year-old woman who underwent thoracoscopic left upper lobectomy after excluding distant metastasis, due to a mixed-density mass in the left upper lobe of the lung. After surgery, the patient's chest pain progressively worsened. On the third postoperative day, she also had symptoms such as chest tightness, atrial fibrillation, tachycardia, and leukocytosis, but no dyspnea. Then, an urgent contrast-enhanced chest computed tomography revealed diffuse ground-glass attenuation in the left lower lobe and a left lower bronchial obstruction. It also revealed that the left inferior pulmonary artery was twisted upward with distal poor filling. A bedside electronic bronchoscopy also found that the left lower lobe bronchus was obviously narrowed and almost completely occluded. Due to high suspicion of left lower lobe torsion, emergency surgery was performed. During the operation, it was found that the left lower lobe had rotated 180° counterclockwise. After evaluating the poor lung vitality, a left lower lobectomy of the lung was performed. The patient recovered well after the operation and no complications occurred during follow-up. CONCLUSIONS This report has highlighted the importance of postoperative imaging following left upper lobectomy; although left lower lobe torsion is a rare complication, it is a potentially life-threatening condition that requires emergency pneumonectomy.