INTRODUCTION: Lobar torsion after pulmonary resection is a rare complication. The reported incidence is 0.089% among 7887 pulmonary resections (2). Although torsion has been reported previously in the setting of open lobectomy, large series of thoracoscopic lobectomy have not reported it (1).
CASE PRESENTATION: A 60-year-old smoker female sustained a traumatic ankle fracture. An open reduction and internal fixation was planned and as part of her preoperative evaluation, she required a chest radiograph. She was found to have an incidental right upper lobe lung nodule. Further work-up proved the lesion to be a non-small cell lung carcinoma. A positron emission tomogram did not reveal mediastinal or distant metastasis and she underwent an uneventful vats (video-assisted thoracoscopic surgery) right upper lobectomy. On post-operative day 3, the patient had a low-grade fever, tachycardia, and continued to require supplemental oxygen. The chest radiograph and the chest CT scan both showed opacification of the middle lobe. Flexible bronchoscopy demonstrated narrowing of the middle lobe orifice and distortion of the bronchus intermedius. The patient was re-explored thoracoscopically and the diagnosis of right middle lobe torsion was confirmed. The middle lobe appeared hepatized and non-viable. A thoracoscopic middle lobectomy was carried out uneventfully. The patient was discharged on the morning of post-operative day 8.
DISCUSSIONS: Prompt recognition of lobar torsion after pulmonary resection is a diagnostic challenge. The Hallmark of making the diagnosis is a chest radiograph showing opacification of the involved lobe without apparent volume loss. CT scan and flexible bronchoscopy are the diagnostic tests of choice. Although torsion has been reported previously in the setting of open lobectomy, large series of thoracoscopic lobectomy have not reported it. The literature on post-lobectomy lobar torsion was reviewed, and to our knowledge, this case represents the first report of a minimally invasive management of lobar torsion following pulmonary resection.
CONCLUSION: Lobar torsion complicating pulmonary resection is a surgical emergency. Prompt diagnosis and re-exploration of the chest are essential componenets of successful management. Although an open approach remains the gold standard, a minimally invasive technique is a feasible alternative.
DISCLOSURE: Jon Wee, None.