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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Article info
Publication history
Published online: February 06, 2022
Accepted:
January 24,
2022
Received in revised form:
January 24,
2022
Received:
December 21,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
