Successful video-assisted thoracoscopic management of the right middle lobe torsion: A rare complication of right upper lobectomy – A report of two cases

Pulle, Mohan Venkatesh; Asaf, Belal Bin; Puri, Harsh Vardhan; Kumar, Arvind

doi:10.4103/lungindia.lungindia_254_19

Cited by 1 publication

(4 citation statements)

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“…1 Clinical features of torsion and RMLS are nonspecific, typically begin on postoperative day 1, and may include dyspnea, fever, chest pain, cough, hypoxia, tachypnea, and tachycardia. 2 However, patients may be asymptomatic. 1 With RML torsion, the lobe twists around its bronchovascular pedicle, which may obstruct the airway and cause vascular compromise and ischemia.…”

Section: Introductionmentioning

confidence: 99%

“…3 Lobar torsion typically requires emergent reexploration, with derotation (detorsion) and pneumopexy when feasible, 4 or resection of nonviable lung. 2,5 The pathophysiology of medical RML atelectasis was described by Graham et al in 1948, 6 with enlarged lymph nodes extrinsically compressing the RML bronchus, in a patient with chronic cough, hemoptysis and recurrent infection. Based on a report by Ueda et al, 7 the postsurgical name RMLS was adopted for a similar scenario that develops after RUL lobectomy (RULL) and consists of RML atelectasis and/or RML bronchial kinking, with or without respiratory symptoms.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…3 Lobar torsion typically requires emergent reexploration, with derotation (detorsion) and pneumopexy when feasible, 4 or resection of nonviable lung. 2,5…”

Section: Introductionmentioning

confidence: 99%

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Right middle lobe syndrome after upper lobectomy: Role of the bronchial angle

Strollo

Donnenberg

Madan

et al. 2022

Asian Cardiovasc Thorac Ann

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Background Right middle lobe syndrome is part of a spectrum of relatively rare but serious conditions that may occur following right upper lobectomy. We aimed to assess whether the preoperative middle lobe bronchial angle on CT predicted patients at risk of developing middle lobe syndrome. Method All patients who had a complete upper lobectomy over 4 years were retrospectively reviewed for clinical and imaging findings of middle lobe syndrome. Patients with previous lung surgery, preoperative chemo- or radiation therapy, or more extensive surgical resection were excluded. Patient demographics and symptoms, the surgical, pathologic and bronchoscopy reports, and pre- and post-operative chest imaging, to include 3D CT reconstructions and measurements of the middle lobe angles in a subset of patients, were retrospectively reviewed. Result One hundred and twenty-eight patients met inclusion criteria. Ten (8%) had middle lobe syndrome based on symptoms and imaging features. Eight had severe middle lobe consolidation. Two had postoperative onset of wheezing, with middle lobe bronchial abnormality on CT. The pre- and postoperative middle lobe bronchial angles of 14 patients without middle lobe syndrome were compared to 10 patients with middle lobe syndrome. The middle lobe bronchus was completely obliterated postoperatively and could not be determined in 1 patient. There was no significant difference between the pre- and postoperative angles in patients with or without middle lobe syndrome. Conclusion Middle lobe syndrome occurred in 8% of patients with right upper lobectomy. The preoperative middle lobe bronchial angle did not predict patients at risk for developing middle lobe syndrome.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…3 Lobar torsion typically requires emergent reexploration, with derotation (detorsion) and pneumopexy when feasible, 4 or resection of nonviable lung. 2,5…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations