INTRODUCTION: We present a case of a patient who developed an acute Lobar Torsion within hours of undergoing a Double Lung transplant.
CASE PRESENTATION: A 65 year old female underwent Double Lung transplant for IPF - with Ischaemic times of 4 hours for the Left lung and 5 hours for the right lung. After the surgery, the patient was moved in a stable condition to the ICU. 4 hours later, the Transplant Fellow was called in to see the patient because of increasing Oxygen requirements. The patient had decreased Breath sounds in the Left Upper lobe on exam and had O2 Saturation of 93% on a FiO2 of 100%. Her Pulmonary Artery Pressures were 67/20. A stat CXR was ordered - that showed evidence of a dense opacity in the Left Upper Lobe. A hematoma was suspected and a Bronchoscopy done immediately. It revealed that the Left Main Bronchus was inaccessible with a fish mouth appearance. The patient was immediately rushed back into the OR and the torsion was corrected. Post surgery, the patient did well and the CXray cleared up in 2 days time - showing that a Pulmonary Infarction, which could have been disastrous in this setting, had been prevented by the speedy intervention.
DISCUSSIONS: Acute Lobar Torsion is a rare but serious complication after a Transplant - with very few cases reported in the literature. As the tracheobronchial tree is twisted in lung torsion, compromise of the pulmonary arterial, venous, and bronchial circulation develops. It is assumed that the risk of Lobar torsion is higher after a Transplant because of the division of the Pulmonary ligament of the donor lung and the size difference between the donor and recepient chest cavity that could potentiate torsion of the donor lung. High Clinical suspicion and prompt diagnosis by Bronchoscopy are essential to intervene early in order to prevent Pulmonary Infarction. The treatment is Surgical Detorsion or removal of the affected Lobe.
CONCLUSION: The possibility of acute lobar torsion should be considered in lung transplant recipients who demonstrate evidence of acute respiratory insufficiency in the early post-operative period.
DISCLOSURE: Vinu Abraham, No Financial Disclosure Information; No Product/Research Disclosure Information