Abstract
Lung torsion is a very rare event that has been described after trauma, spontaneously,
and post–thoracic surgery, with only 8 cases reported in the pediatric literature.
We present the first case report of lung torsion complicating tracheoesophageal fistula
repair. The diagnosis was suggested on chest ultrasonogram and Doppler and confirmed
by computed tomographic scans. On exploration, a 90° rotation of the right middle
and lower lobes in a clockwise direction was found. A complete interlobar fissure
and an absent inferior pulmonary ligament were identified as predisposing factors.
The lobes were untwisted, and lobar fixation was performed to prevent retorsion. Postoperatively,
the patient recovered complete lung function, and the patient's chest radiologic and
ultrasonographic examination results normalized. Lung torsion is an extremely uncommon
event. It causes clinical deterioration in the face of normal arterial blood gases
and requires a high index of suspicion for diagnosis. Resection of the twisted lung
or lobe may be unnecessary if diagnosis is made early and vascular occlusion is partial.
Patients with complete interlobar fissures may benefit from pulmonary lobe fixation
as a prophylaxis against occurrence or recurrence of this complication.
Index words
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References
- Pulmonary torsion after cardiac surgery in two infants: review of pediatric literature.J Pediatr Surg. 2004; 39: 1719-1723
- Torsion of the lung following thoracic trauma; a case report.Radiology. 1954; 62: 726-727
- Traumatic torsion of the lung.Radiology. 1956; 67: 582-583
- Traumatic torsion of the lung.N Engl J Med. 1957; 256: 385-388
- Torsion of a lobe of the lung due to blunt thoracic trauma.Ann Thorac Surg. 1967; 4: 166-170
- New pathological findings in emphysema of childhood. 2, Overinflation of a normal lobe.Thorax. 1971; 26: 190-194
- Lung torsion: survival of a patient whose hemorrhagic infarcted lung remained in situ after detorsion.J Thorac Cardiovasc Surg. 1990; 99: 1112-1114
- Lobar torsion after pulmonary resection; report of two cases.Ann Thorac Cardiovasc Surg. 2006; 12: 63-65
- Torsion of the lung without trauma.Radiology. 1979; 132: 25-26
- Lobar torsion after pulmonary resection: presentation and outcome.J Thorac Cardiovasc Surg. 2001; 122: 1091-1093
- Causes and presenting features of pulmonary infarctions in 43 cases identified by surgical lung biopsy.Chest. 2005; 127: 1178-1183
- Fatal stroke after completion pneumonectomy for torsion of left upper lobe following left lower lobectomy.J Cardiothorac Surg. 2006; 1: 25
- Partial pulmonary torsion after thoracotomy without pulmonary resection.J Trauma. 2005; 59: 478-481
- Clinical and radiographic signs lead to early detection of lobar torsion and subsequent successful intervention.J Thorac Cardiovasc Surg. 2006; 132: 720-721
- Postoperative lobar torsion and gangrene.Thorax. 1977; 32: 501-504
- Lung torsion: radiographic findings in nine cases.Radiology. 1987; 162: 631-638
- Lobar torsion complicating bilateral lung transplantation.J Heart Lung Transplant. 2003; 22: 102-106
- Unrecognized intraoperative torsion of the lung.Surgery. 1981; 89: 390-393
- Radiographic and CT findings in complications following pulmonary resection.Radiographics. 2002; 22: 67-86
- Lung torsion: preoperative diagnosis with angiography and computed tomography.J Thorac Imaging. 1998; 13: 42-44
- Lung torsion after lung transplantation: evaluation with helical CT.AJR Am J Roentgenol. 2000; 174: 1341-1343
- Torsion of the upper lobe of the lung after surgery: findings on pulmonary angiography.AJR Am J Roentgenol. 1991; 157: 471-472
- Pleural flap to prevent lobar torsion: a novel technique.Eur J Cardiothorac Surg. 2006; 30: 943-944
- Acute postoperative lobar torsion associated with pulmonary arterial rupture.J Thorac Cardiovasc Surg. 2003; 126: 303
- Middle lobe torsion following right upper lobectomy.Radiology. 1985; 155: 580
- Pulmonary torsion: a questionnaire survey and a survey of the literature.Ann Thorac Surg. 1992; 54: 286-288
Article info
Publication history
Accepted:
July 7,
2007
Received in revised form:
July 6,
2007
Received:
May 27,
2007
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
