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

Published:February 06, 2022DOI:


      • 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.



      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.


      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.


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        • Stephens G.
        • Bhagwat K.
        • Pick A.
        • McGiffin D.
        Lobar torsion following bilateral lung transplantation.
        J Card Surg. 2015; 30: 209-214
        • Lin M.-W.
        • Huang S.-C.
        • Kuo S.-W.
        • Huang P.-M.
        • Hsu H.-H.
        • Lee Y.-C.
        Lobar torsion after lung transplantation.
        J Formos Med Assoc. 2013; 112: 105-108
        • Souilamas R.
        • Saueressig M.
        • Boussaud V.
        • Amrein C.
        • Guillemain R.
        • Sonett J.
        Pulmonary resection after lung transplantation in cystic fibrosis patients.
        Asian Cardiovasc Thorac Ann. 2011; 3: 202-206
        • Shakoor H.
        • Murthy S.
        • Mason D.
        • et al.
        Lobar torsion after lung transplantation—a case report and review of the literature.
        Artif Organs. 2009; 33: 551-554
        • Grazia T.J.
        • Hodges T.N.
        • Cleveland J.C.
        • Sheridan B.C.
        • Zamora M.R.
        Lobar torsion complicating bilateral lung transplantation.
        J Heart Lung Transplant. 2003; 22: 102-106
        • Collins J.
        • Kuhlman J.E.
        • Love R.B.
        Acute, life-threatening complications of lung transplantation.
        Radiographics. 1998; 18: 21-43
        • Hayashi K.
        • Aziz A.
        • Ashizawa K.
        • Hayashi H.
        • Nagaoki K.
        • Otsuji H.
        Radiographic and CT appearances of the major fissures.
        Radiographics. 2001; 21: 861-874
        • Gilkeson R.C.
        • Lange P.
        • Kirby T.J.
        Lung torsion after lung transplantation evaluation with helical CT.
        Am J Roentgenol. 2000; 174: 1341-1343
        • MR DeFreitas
        • HP McAdams
        • Ali H.A.
        • Iranmanesh A.M.
        • Chalian H.
        Complications of lung transplantation: update on imaging manifestations and management.
        Radiol Cardiothorac Imaging. 2021; 3 (Published online)
        • Felson B.
        Lung torsion: radiographic findings in nine cases.
        Radiology. 1987; 162: 631-638
        • Cox C.S.
        • Decker S.J.
        • Rolfe M.
        • Hazelton T.R.
        • Rojas C.A.
        Middle lobe torsion after unilateral lung transplant.
        J Radiol Case Rep. 2016; 10: 15-21