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Weekly Chest CasesArchive of Old Cases

Case No : 991 Date 2016-10-24

  • Courtesy of Chan Ho Park, Sang Young Oh, Kyung Hyun Do / Asan Medical Center
  • Age/Sex 69 / F
  • Chief ComplaintChest radiographic abnormality on postoperative check up
  • Figure 1
  • Figure 2

#POD 1

Diagnosis With Brief Discussion

Diagnosis
Lung torsion
Radiologic Findings
First Chest PA shows increased opacity in right upper lung field, and follow-up chest PA shows rapidly progressing collapse and consolidation, suggesting lung torsion. We suspected lung torsion and recommended chest CT for further evaluation. Chest CT scan images with mediastinal window settings show twisting and narrowing of right middle lobe bronchus with swirling appearance of the bronchovascular structures. Pulmonary vessels still show enhancement after contrast infusion however. On thoracotomy, there was torsion of the right middle lobe. De-torsion was performed as the right middle lobe appeared viable.
Brief Review
Lung torsion is an uncommon disease that occurs mostly after lung resection (usually lobectomy or lingulectomy) and only rarely in thoracic trauma. It has also been described after lung transplantation, after fine-needle aspiration biopsy, and in patients with spontaneous pneumothorax. Right middle lobe is the most commonly involved site after lung resection, but other lobes can also be involved.
The early diagnosis of lung torsion is important because pulmonary hemorrhagic infarction or fatal gangrene can occur. However, it is often difficult or almost impossible to make early diagnosis because of its rare incidence and nonspecific clinical symptoms. Thus, a high index of suspicion is necessary.
Chest radiographic signs of lung torsion include a rapidly progressing consolidation, displacement of the hilar structures, bronchial cut-off or distortion. Atelectasis due to airway obstruction, abnormal positioning and orientation of pulmonary vessels and bronchi within the atelectatic lobe, abnormal position of the hilum in relation to the atelectatic lobe, and rapid expansion of an abnormally located consolidated lobe may also be seen.
CT findings include tapered obliteration of the proximal pulmonary artery and accompanying bronchus of the involved lobe and amorphous soft-tissue attenuation at the hilum. The torsed lobe demonstrates poorly enhancing consolidation with increased volume, ground-glass attenuation, interlobular septal thickening, and intralobular linear attenuation.
Please refer to
Case 93, Case 171, Case 317, Case 943,
References
Kim EA, Lee KS, Shim YM, et al. Radiographic and CT findings in complications following pulmonary resection. Radiographics 2002 ;22 :67-86.
Chung SH, Nam JE, Choe KO, et al. Radiologic findings of lung lobe torsion in reconstructed multidetector computed tomography image lead to early detection. Clinical Imaging 2010; 34 :400-403.
Chen CH, Hung TT, Chen TY, et al. Torsion of right middle lobe after a right upper lobectomy. Journal of cardiothoracic surgery 2009; 4: 16.
Keywords
Lung, Iatrogenic lung disease,

No. of Applicants : 93

▶ Correct Answer : 57/93,  61.3%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Ulsan University Hospital , Korea (South) Soyeoun Lim
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Shanghai Jiao Tong University Affiliated Sixth People , China Jiayin Zhang
  • - , Korea (South) Seon Park
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Korea University Guro Hospital , Korea (South) Bit Na Park
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Seoul national university , Korea (South) Boram Kim
  • - Private SECTOR - ITALY , Italy CARLO FLORIO
  • - Ajou university hospital , Korea (South) DONGHYUN LEE
  • - Kyungpook national university , Korea (South) Chungeun Lim
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - �stanbul , Turkey Ayhan Yilmaz
  • - privato , Italy genchi enzo
  • - university of montreal , Canada Andrei Gorgos I
  • - , Korea (South) BAEK YOOLIM
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - CNUH , Korea (South) LEE JAE
  • - Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
  • - 異⑸ , Korea (South) 蹂€
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - Samsung medical center , Korea (South) Ran Kim
  • - Medicheck health care , Korea (South) Chae Lim
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
  • - University of Tsukuba Hospital , Japan Hiroaki Takahashi
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - University of Toronto , Canada Micheal McInnis
  • - University of Tsukuba, Dept of Radiology , Japan Manabu Minami
  • - Kyungpook national university hospital, Korea , Korea (South) Sung Jun Moon
  • - Samsung Medical Center , Korea (South) Boda Nam
  • - Ajou university hospital , Korea (South)
  • - Seoul National University Bundang Hospital , Korea (South) Jee Hye Hur
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Seoul national university hospital , Korea (South) Kumju Chae
  • - GHICL , France manuel toledano
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu-chong
  • - Korea university medical center, guro hospital , Korea (South) JINWOO HAN
  • - Ajou University Hospital , Korea (South) Seulgi You
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - ROKAF 10th Fighter Wing , Korea (South) Kun Woo Kang
  • - The University of Tokyo Hospital , Japan Kaoru Sumida
  • - Seoul National University Hospital , Korea (South) Sunkyung Jeon
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
  • - Private sector , Greece Vasilios Tzilas
  • - SNUH , Korea (South) Juil Park
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Ajou University Hospital , Korea (South) Youngjin Yoo
▶ Correct Answer as Differential Diagnosis : 5/93,  5.4%
  • - Chungbuk national university , Korea (South) Yong Kim
  • - chungbuk national university hospital , Korea (South) lee jung hwan
  • - Chungbuk national university hospital , Korea (South) Miran Yeon
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - chungbuk university hospital , Korea (South) Hyeonmi Ryu
▶ Semi-Correct Answer : 4/93,  4.3%
  • - CH ANNECY , France Charles DARAGON
  • - 紐…吏€蹂‘ , Korea (South) Kyung Ho Kim
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The Jikei university , Japan Taku Gomi
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