Pulmonary torsion: A questionnaire survey and a survey of the literature

Wong, Poo Sing; Goldstraw, Peter

doi:10.1016/0003-4975(92)91386-n

Cited by 77 publications

(60 citation statements)

References 16 publications

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“…It is reported that the middle lobe of the right lung is most implicated, but pulmonary torsion may also occur with any other lobe. 1,3 A case of left upper lobe torsion following lingulectomy has been reported, 3 but we could fi nd no reported cases of torsion of the lingula in a PubMed search. This is the fi rst case report of pulmonary torsion of the lingula following segmentectomy of the left upper division.…”

Section: Discussionmentioning

confidence: 93%

Pulmonary torsion of the lingula following a segmentectomy of the left upper division

Eguchi

Katō

Shiina

et al. 2008

Gen Thorac Cardiovasc Surg

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We report a case of pulmonary torsion of the lingula. Thoracoscopic segmentectomy of the left upper division was performed on a 67-year-old woman. The chest radiograph on the first postoperative day showed consolidation in the left apical area. By the second postoperative day, the consolidation had increased in size. Bronchoscopy and chest contrast-enhanced computed tomography (CT) were conducted, and she was diagnosed with torsion of the lingula. We performed an emergency operation and resected the affected lung because of a gangrenous lobe. Although pulmonary torsion is a rare complication following lung resection, thoracic surgeons should always consider the risk. To prevent pulmonary torsion, we should confirm the correct position of the remaining lobes, and fixation of the lobes should be performed if there is little or no parenchymal bridge between contiguous lobes. A high index of clinical suspicion is necessary for early diagnosis, and rethoracotomy should be performed without delay.

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Section: Discussionmentioning

confidence: 93%

Pulmonary torsion of the lingula following a segmentectomy of the left upper division

Eguchi

Katō

Shiina

et al. 2008

Gen Thorac Cardiovasc Surg

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“…The remaining middle lobe after the upper and lower bilobectomy is at risk of torsion because it is freely movable in the large thoracic cavity. The torsion of the middle lobe has been also reported after ipsilateral upper or lower lobectomy [7]. The factors related to lobar torsion include complete interlobar fissure, absence of adhesion, a narrow middle lobe hilum, and overzealous mobilization of the lobe [8].…”

Section: Commentmentioning

confidence: 97%

Middle lobe preservation and fixation: right upper and lower sleeve bilobectomy. How to do it

et al. 2012

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We herein report the case of a 65-year-old female with primary lung cancer who underwent a right upper and lower sleeve bilobectomy. The radiological findings revealed that the tumor was located in the superior segment of the right lower lobe and had invaded the posterior segment of the upper lobe and the truncus intermedius. We performed a right upper and lower sleeve bilobectomy. A latissimus dorsi flap was utilized to separate the thoracic cavity into upper and lower portions, and the preserved middle lobe was fixed in the upper portion to prevent torsion. Postoperative radiography showed good expansion of the middle lobe.

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“…Arai et al 7) reported bronchial deformation of the left lower lobe bronchus after left upper lobectomy. Wong et al 8) reported 28 cases of lobar torsion after lung resection; 16 (57%) of these 28 cases involved middle lobe torsion after right upper lobectomy. The others involved left upper lobe torsion after left lower lobectomy, and right lower lobe torsion after right upper lobectomy.…”

Section: Editorialmentioning

confidence: 99%

“…He recommended that care be taken to prevent torsion of the remaining lobes, which may become fixed together by suturing, and complete re-expansion of the lung during chest closure is essential to prevent lung lobar torsion. Wong et al 8) recommended that, after lobectomy, the remaining lobe(s) be anchored with sutures to minimize the likelihood of pulmonary torsion.…”

Section: Editorialmentioning

confidence: 99%

“…Wong et al 8) reported that some rotation/kinking of the right middle lobe bronchus with atelectasis of the middle lobe is a common postoperative condition after right upper lobectomy. They insisted that the right middle lobe relocated into the upper thorax anterior to the superior segment of the lower lobe and adjacent to the superior vena cava.…”

Section: Editorialmentioning

confidence: 99%

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Bronchial Deformation Associated with Lobectomy

Kadokura

2015

ATCS

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EditorialBronchial stenosis or obstruction (BSO) can arise as a congenital disorder with other associated abnormalities, but it may also occur as an acquired lesion secondary to other conditions. 1-4) BSO after chest surgery is a relatively rare condition. BSO after upper lobectomy probably occurs due to upward movement of the remaining lobe(s) with torsion or deformation of the bronchus. The diagnosis of BSO can be confirmed at the time of bronchofiberscopy (BF) or computed tomography (CT) scan by the findings of a kinked lobar bronchus. Bronchofiberscopic findings will show partial or complete obstruction of the bronchus to the affected lobe, which is caused by edema or distortion. In addition, there are some radiological findings of lung lobar torsion: (1) a collapsed or consolidated lobe that occupies an unusual position on chest roentgenography or CT scan; (2) hilar displacement in a direction inappropriate for the lobe that appears to be atelectasis; (3) alteration in the normal position and sweep of the pulmonary vasculature-if central vascular markings extend laterally from the hilus and then sweep superiorly instead of inferiorly, lobar torsion can be postulated; (4) rapid opacification of an ipsilateral lobe following chest surgery-the thorax may be completely opaque, especially if an entire lung has undergone torsion; (5) a change in position of an opacified lobe on sequentially obtained chest roentgenography; (6) bronchial distortion, demonstrated occasionally on chest roentgenography, but better seen on CT scans; (7) lobar air trapping; and (8) signs of lobar collapse. 5) Among the various reasons for bronchial deformation, lung torsion is fatal. Brooks 6) described that lung lobar torsion of the right middle lobe after upper lobectomy is the most common, but it can occur in all lobes. Arai et al. 7) reported bronchial deformation of the left lower lobe bronchus after left upper lobectomy. Wong et al. 8) reported 28 cases of lobar torsion after lung resection; 16 (57%) of these 28 cases involved middle lobe torsion after right upper lobectomy. The others involved left upper lobe torsion after left lower lobectomy, and right lower lobe torsion after right upper lobectomy. There are published articles on left lower lobe torsion after left upper lobectomy, as well as right lower lobe torsion after right upper lobectomy. 9) Brooks 6) asserted that the fissure must be completely isolated between the remaining lobes. Furthermore, torsion of the lower lobe cannot occur if the inferior pulmonary ligament is not divided. He recommended that care be taken to prevent torsion of the remaining lobes, which may become fixed together by suturing, and complete re-expansion of the lung during chest closure is essential to prevent lung lobar torsion. Wong et al. 8) recommended that, after lobectomy, the remaining lobe(s) be anchored with sutures to minimize the likelihood of pulmonary torsion. Khanbhai et al. 10) reported that the division of the pulmonary ligament reduces the free space in the upper thorax and may...

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Pulmonary torsion: A questionnaire survey and a survey of the literature

Cited by 77 publications

References 16 publications

Pulmonary torsion of the lingula following a segmentectomy of the left upper division

Pulmonary torsion of the lingula following a segmentectomy of the left upper division

Middle lobe preservation and fixation: right upper and lower sleeve bilobectomy. How to do it

Bronchial Deformation Associated with Lobectomy

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