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Donato BB, Sewell M, Al Harakeh H, Sen A, Patel BM, Morgan P, Mathur AK, Moss AA, Hewitt WR, Campany ME, Dulohery Scrondin MM, Cassivi SD, Gajic O, D'Cunha J. Spontaneous middle lobe torsion: An institutional case series. JTCVS Tech 2023; 20:176-181. [PMID: 37555057 PMCID: PMC10405155 DOI: 10.1016/j.xjtc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE Lobar torsion is a rare occurrence in which a portion of the lung is twisted on its bronchovascular pedicle. The vast majority are observed in the acute postoperative period often following right upper lobectomy. Spontaneous middle lobe torsion independent of pulmonary resection is exceptionally rarer; fewer than 15 cases have been recorded. We present an institutional case series of 2 patients postorthotopic liver transplantation who developed spontaneous middle lobe torsion due to large pleural effusions. METHODS We provide the medical course as well as intraoperative techniques for our 2 patients along with a review of the literature. RESULTS Both patients in this case series underwent orthotopic liver transplant complicated postoperatively by a large pulmonary effusion. Patient one developed an abdominal hematoma requiring evacuation and repair, after which he developed progressive shortness of breath. Bronchoscopy revealed a right middle lobe obstruction; upon thoracotomy, 180-degree torsion with widespread necrosis was evident and the middle lobe was removed. He is doing well to date. Patient 2 experienced postoperative pleural effusion and mucus plugging; computed tomography revealed abrupt middle lobe arterial occlusion prompting urgent operative intervention. Again, the middle lobe was grossly ischemic and dissection revealed a 360-degree torsion around the pedicle. It was resected. He is doing well to date. CONCLUSIONS As the result of its rarity, radiographic and clinical diagnosis of spontaneous pulmonary lobar torsion is challenging; a high index of suspicion for spontaneous middle lobe torsion must be maintained to avoid delays in diagnosis. Prompt surgical intervention is essential to improve patient outcomes.
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Affiliation(s)
| | - Marisa Sewell
- Department of Surgery, Oregon Health & Science University, Portland, Ore
| | | | - Ayan Sen
- Department of Critical Care Medicine, Mayo Clinic Arizona, Phoenix, Ariz
| | - Bhavesh M. Patel
- Department of Critical Care Medicine, Mayo Clinic Arizona, Phoenix, Ariz
| | - Paige Morgan
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Ariz
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic Hospital, Rochester, Minn
| | - Amit K. Mathur
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Ariz
| | - Adyr A. Moss
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Ariz
| | | | | | | | - Stephen D. Cassivi
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic Hospital, Rochester, Minn
| | - Ognjen Gajic
- Department of Critical Care Medicine, Mayo Clinic Hospital, Rochester, Minn
| | - Jonathan D'Cunha
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, Ariz
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Akatsuka M, Yama N, Iba Y, Masuda Y. Pulmonary torsion due to omentopexy after replacement of the descending aorta and esophagectomy. Oxf Med Case Reports 2022; 2022:omac122. [DOI: 10.1093/omcr/omac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/19/2022] [Accepted: 09/23/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Masayuki Akatsuka
- Sapporo Medical University School of Medicine Department of Intensive Care Medicine, , Sapporo, Hokkaido, Japan
| | - Naoya Yama
- Sapporo Medical University School of Medicine Department of Diagnostic Radiology, , Sapporo, Hokkaido, Japan
| | - Yutaka Iba
- Sapporo Medical University School of Medicine Department of Cardiovascular Surgery, , Sapporo, Hokkaido, Japan
| | - Yoshiki Masuda
- Sapporo Medical University School of Medicine Department of Intensive Care Medicine, , Sapporo, Hokkaido, Japan
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Hara D, Hamahiro T, Maeda R, Ayabe T, Tomita M. Pulmonary torsion after resuscitative thoracotomy: a case report. J Surg Case Rep 2021; 2021:rjab313. [PMID: 34290852 PMCID: PMC8289312 DOI: 10.1093/jscr/rjab313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/24/2021] [Indexed: 11/14/2022] Open
Abstract
We report a rare case of pulmonary torsion after nonpulmonary thoracotomy. A 38-year-old woman with schizophrenia committed suicide by a self-infliction of sharp force into the chest and abdomen. During emergent abdominal damage control surgery, a left-sided resuscitative thoracostomy was also performed due to hemorrhagic shock. Although abnormal shadow was detected on postoperative chest roentgenogram and computed tomography, the diagnosis of pulmonary torsion was delayed. Seven days after initial surgery, pulmonary torsion was diagnosed and managed by left upper lobectomy. To our knowledge, this is the first report of pulmonary torsion after resuscitative thoracotomy.
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Affiliation(s)
- Daisuke Hara
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - Tomoka Hamahiro
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - Ryo Maeda
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - Takanori Ayabe
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - Masaki Tomita
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
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