Lobar Torsion After Lung Transplantation—A Case Report and Review of the Literature

Abstract

Lobar torsion is a rare complication following lung transplantation. Early detection and immediate therapeutic intervention can lead to a favorable outcome. We report an unusual case of left lingular torsion following single lung transplantation performed for idiopathic pulmonary fibrosis. The patient experienced severe ventilatory compromise immediately after leaving the operating room, and a chest X-ray revealed a well-demarcated area of consolidation involving the left mid- and lower lung zones. Lingular torsion was promptly diagnosed and corrected surgically. The possibility of acute lobar torsion should be considered in lung transplant recipients who experience acute respiratory compromise in the early postoperative period. Early diagnosis and correction can avoid pulmonary infarction and the need for lobar resection.

Lobar Torsion Following Bilateral Lung Transplantation

“…The technique of lung transplantation together with these risk factors may increase the potential mobility of the lobe within the chest cavity . There is a higher incidence of torsion of the left lung lobes compared to right lung lobes seen in the reported cases, probably because the left lung has a higher incidence of complete fissures, found in as many as 27–82% of donors, and the relatively long pulmonary artery and main bronchus.…”

“…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 . A review of the literature shows that a delay in the diagnosis and treatment of this rare complication can have catastrophic consequences such as obstructive pneumonia, hemoptysis, hypoxemia, bronchorrhea, and persistent air leak.…”

“…Atelectatic lobes of the donor lung may increase mobility of the graft within the larger chest cavity resulting in partial or complete torsion. Additionally, the use of double lumen tubes for decompression of the lung can potentially predispose to the development of lobar torsion that may be overlooked upon reinflation …”

“…The compromised ability to visualize the graft while repeatedly checking for hemostasis can contribute to subsequent lobar torsion. The anterolateral incision could also contribute to this poor visualization of the graft …”

“…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.…”