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Left upper lobe and lingula torsion after transplantation of single lung with complete major and minor fissures: A case report

Published:February 06, 2022DOI:https://doi.org/10.1016/j.clinimag.2022.01.013

      Highlights

      • Presence of complete major and minor fissures can increase the risk of torsion.
      • CT and/or CTA are useful modalities to detect lung torsion.
      • Lack of contrast in pulmonary vessels, high-grade narrowing of bronchus, abnormal location of segment are imaging findings.
      • Anatomical defects in transplanted lungs plus significant manipulation during surgery can increase the risk of torsion.

      Abstract

      Background

      Native lung torsion is rare and torsion in a lung transplant is even rarer.

      Case presentation

      Here we report a case of left upper lobe (LUL) and lingula torsion in a patient with a unilateral left lung transplantation. The transplant was complicated by a graft with a short pulmonary artery cuff, which required significant vascular reconstruction and manipulation. Additionally, the graft had complete left major and minor fissures, which are documented risk factors for torsion. After 24 h postoperatively, the patient failed to wean off ventilation. The patient was worked up with bronchoscopy, a computed tomography (CT), and a CT angiogram (CTA). A CT without intravenous (IV) contrast showed the findings suggestive of torsion of the LUL and lingula and the CTA confirmed the diagnosis. Immediate re-exploration was performed for detorsion to preserve the vitality of the allograft. Following the failed detorsion, the patient had re-transplantation of the left lung with good results.

      Conclusion

      Lung torsion should be watched for in patients with major risk factors like complete fissure. CT and/or CTA are effective tools to confirm the diagnosis.

      Keywords

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