Postoperative Pulmonary Torsion: Report of a Case and Survey of the Literature Including Spontaneous and Posttraumatic Torsion

Schamaun, M

doi:10.1055/s-2007-1016469

Cited by 40 publications

(26 citation statements)

References 2 publications

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“…Signs and symptoms of torsion include sudden and unexplained dyspnea and tachypnea refractory to oxygen supplementation, early high fever, and copious secretions (hemorrhagic or clear) [41]. Chest x-ray may demonstrate sudden opacification of previously expanded lobe, see Figures 6 and 7. Diagnosis is confirmed with bronchoscopy, with visualization of a compressed lobar bronchus with a classic "fish mouth" appearance [42]. CT scan with contrast will demonstrate loss of blood flow and bronchial cut-off.…”

Section: Prevention Strategiesmentioning

confidence: 96%

Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

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INTRODUCTIONThe most effective management of postoperative crises is prevention. This starts with preoperative preparation and patient screening. There are many factors that can be controlled and improved by the patient, including but not limited to, smoking cessation, cardiopulmonary rehab and teaching/setting peri-operative expectations. Equally as important is patient selection, which is influenced by pulmonary function tests, cardiopulmonary reserve, and pre-existing comorbidities. After the operation, the care team can also greatly improve outcomes with aggressive cardiopulmonary therapies, ambulation, vigilant monitoring and frequent assessments of the patient. Even when all of these guidelines are followed not all early complications can be avoided.A recent review of the National Cancer Database by Rosen et al found a 2.6% mortality from lobectomy [1]. Morbidity associated with lobectomy is 10% to 50%, and increases in the elderly [2]. The population being treated by thoracic surgeons continues to age and the complexity of the operations is increasing as neoadjuvant therapies become more prevalent. Early postoperative crises after lobectomy will occur, necessitating prompt and effective management strategies. The most common complications after pulmonary resection are listed below in Table 1, in this chapter we will focus on the early complications after lobectomy [3].For the purposes of this chapter we will define early post-operative crisis as those that develop within 48 hours of the operation. AIR LEAKProlonged air leak is the most common complication after pulmonary resection, with a reported incidence of 15-18% [4]. Prolonged air leak is defined as a leak lasted more than 7 days after pulmonary resection. Cerfolio et al reported an incidence of 25% on postoperative day 1 and 20% on postoperative day 2 [5,6] U.S. Department of Veterans AffairsPublic Access Author manuscript VA Author ManuscriptVA Author Manuscript VA Author Manuscript parenchymal air leaks post-operatively and a variety of factors that influence any given patients propensity for developing an air leak. Patient factors that increase risk of developing an air leak include emphysematous lungs, larger parenchymal resection and therefore less parenchymal apposition to chest wall, and inadequate drainage of air by thoracostomy tube(s). PREVENTION STRATEGIES1. Bronchial stump buttressing with a muscle flap. In patients with an infected pleural space or who are on chronic immunosuppression, coverage of the stump with vascularized muscle may prevent bronchial stump breakdown [7]. The intercostal muscle is an excellent coverage option and is harvested from the intercostal space upon entry into the chest at the level of the thoracotomy. It is important to plan ahead, as this muscle needs to be harvested prior to placing the rib spreader in an open operation to prevent crushing the vascular supply. Dissection is begun on the inferior rib and the muscle is mobilized using a periosteal elevator posteriorly to the paraspinous muscle. Attention is...

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Section: Prevention Strategiesmentioning

confidence: 96%

Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

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“…Its etiology appears to be threefold: secondary to trauma, after thoracic surgery, and spontaneously11). Predisposing factors of lung torsion have been known to include an airless lobe, a long and free lobar pedicle, the absence of a parenchymal bridge between contiguous lobes, pneumothorax or pleural effusion, and the transection of the inferior pulmonary ligament12).…”

Section: Discussionmentioning

confidence: 99%

Lung torsion after tracheoesophageal fistula repair in an infant

et al. 2013

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Lung torsion is a very rare event that has been reported in only 9 cases in the pediatric literature but has not yet been reported in Korean infants. We present a case of lung torsion after tracheoesophageal fistula repair in an infant. Bloody secretion from the endotracheal tube and chest radiographs and computed tomographic scan results indicated lung torsion. Emergency exploration indicated 180° torsion of the right upper lobe (RUL) and right middle lobe (RML). After detorsion of both lobes, some improvement in the RUL color was observed, but the color change in the RML could not be determined. Although viability of the RML could not be proven, pexy was performed for both the lobes. Despite reoperation, clinical signs and symptoms did not improve. The bronchoscopy revealed a patent airway in the RUL but not in the RML. Finally, the RML was surgically removed. The patient was discharged on the 42nd day after birth.

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“…In addition, the patient's condition was complicated by intrathoracic hemorrhaging on the 8th postoperative day, and the fact that the patient's chest CT revealed torsion of the residual left lower lobe. Torsion of the left lower lobe is a rare complication of left upper lobectomy, 7,8 and was probably due to the unusual anatomical rotation of the hilum and postoperative overexpansion of the residual lower lobe. This torsion remitted spontaneously, but other unexpected complications due to anatomical abnormalities might develop in the early phase of the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary resection for lung cancer with impaired pulmonary function due to severe spinal deformity: Report of a case

et al. 2011

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A 58-year-old man underwent surgery for the treatment of lung adenocarcinoma at our hospital. He had a history of spinal caries at the age of 3 and frequent recurrent asthma-like symptoms thereafter. Chest plain radiography revealed an irregularly shaped mass in the left hilum and a thoracic cage severely deformed by kyphosis. A pulmonary function test demonstrated a severe restrictive ventilation pattern. He underwent a left upper lobectomy without mediastinal dissection. His asthma-like symptoms were exacerbated by difficulty in expectoration of sputum for several days after surgery, but the symptoms disappeared without any medical care. Dyspnea, hemoptysis, and intrathoracic hemorrhage were observed on the 8th postoperative day. Computed tomography revealed torsion of the residual left lower lobe, but the symptoms spontaneously disappeared in a week. The patient had complained of frequent coughing and mild dyspnea on exertion for years, but his quality of life was unchanged after the lobectomy. Bone metastasis was detected 3 years after the surgery, and the patient then underwent chemotherapy. However, he died of the disease 4 years 2 months after the surgery.

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Postoperative Pulmonary Torsion: Report of a Case and Survey of the Literature Including Spontaneous and Posttraumatic Torsion

Cited by 40 publications

References 2 publications

Postlobectomy Early Complications

Postlobectomy Early Complications

Lung torsion after tracheoesophageal fistula repair in an infant

Pulmonary resection for lung cancer with impaired pulmonary function due to severe spinal deformity: Report of a case

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