Lobar torsions are rare and usually an adverse event of pulmonary lobectomies. The most frequently seen is the torsion of the middle lobe following a right upper lobectomy.1–3 Spontaneous lung torsions are even more rare. According to Ohde et al,4 only approximately 10 cases had been reported before year 2005. Most cases were related to pneumothorax.5 To our knowledge, only one case of spontaneous torsion of the right middle lobe associated with pleural effusion has been reported.4 It can be speculated that torsion of the middle lobe is possible only in patients with an abnormally long bronchovascular pedicle and fully complete fissures. If a pneumothorax, for example, occurs, or if one of the lobes is compressed by a pleural effusion, this mobile middle lobe can rotate. Once turned and congested by the sudden interruption of venous drainage, the lobe becomes heavy and may not spontaneously come back to its anatomically normal situation. Urgent operation is required because of the high risk of mortality related to necrosis and infection of the lobe.6 Only in 2007 was the use of a video-assisted thoracic surgery for postoperative torsion reported.3 In our observation, because the diagnosis was highly suspected from the radiologic findings, we chose a full thoracoscopic approach,7 assuming that surgery would likely be straightforward, and it was, due to the patient's peculiar anatomy of a long pedicle and complete fissures.