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