Lobar torsion after lung transplantation

Abstract

Lobar torsion is a rare complication after lung transplantation. Here we report a case of right middle lobe (RML) torsion after bilateral sequential lung transplantation (BLTx). This 30-year-old lady underwent BLTx for bronchiolitis obliterans due to paraneoplastic pemphigus. The right lower lobe of the donor lung was resected due to inflammatory change during procurement. The postoperative chest X-ray showed persisting RML infiltrates. Fever and leukocytosis were noted 1 week later. RML lobectomy was performed after the reconstructed chest computed tomography confirmed the diagnosis of RML torsion. Adult respiratory distress syndrome with unstable vital signs, refractory hypoxemia and respiratory acidosis occurred thereafter. After venoarterial extracorporeal membrane oxygenation support, the patient recovered slowly and was discharged 5 months after BLTx.

Lobar Torsion Following Bilateral Lung Transplantation

“…Lobar torsion is extremely rare after lung transplantation. This complication has a reported incidence of 0.089–0.3%, occurring most frequently after lung resection . It has also been reported after a transthoracic needle aspiration, in association with pneumonia, pleural effusions, abdominal surgery, traumatic pneumothorax, and a diaphragmatic hernia .…”

“…Few lobar torsions following lung transplantation have been reported in the literature . Immediate surgical correction is required to correct the torsion and reduce the associated high mortality rate.…”

“…Few lobar torsions following lung transplantation have been reported in the literature. [1][2][3][4][5][6][7] Immediate surgical correction is required to correct the torsion and reduce the associated high mortality rate. We report a case of lobar torsion following lung transplantation and review the literature on this subject.…”

A Single-Lung Transplantation Complicated by Torsion of the Donor Lung: Diagnosis by Intraoperative Transesophageal Echocardiography

“…These factors are thought to increase lung mobility and, therefore, place the recipient at higher risk for torsion. 3 There are fewer than 60 reported cases of lung torsion after transplantation, 2 and the few case reports available describe a subacute presentation evident in the postoperative period. Intraoperatively, close attention to PAPs and a thorough bronchoscopic examination aid in detection of acute torsion; however, in this case, normal initial bronchoscopy may have led to a missed diagnosis had not a complete post-reperfusion TEE examination revealed markedly abnormal pulmonary venous tracings.…”

“…When diagnosis is delayed even by only several hours, lung resection and extracorporeal membrane oxygenation may be necessary. 3 …”