대한흉부영상의학회 Korean Society of Thoracic Radiology

대한흉부영상의학회 Weekly Case 메뉴

Close

대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
Advanced Search..

Close

Weekly Chest CasesArchive of Old Cases

Case No : 1066 Date 2018-04-02

  • Courtesy of Hyun-ju Lim, MD, Kun Young Lim, MD, Soo Hyun Lee, MD, Hyae Young Kim, MD / National Cancer Center
  • Age/Sex 78 / M
  • Chief Complaintpost-operative status for lung cancer, increasing WBC and C-reactive protein level
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Right Middle Lobe Torsion
Radiologic Findings
Fig 1. Chest radiograph taken immediately after right upper lobectomy shows no abnormal post-operative finding.
Fig 2. Abnormally increased opacity has developed in right upper to mid lung zone on follow-up chest radiograph taken after one week.
Figs 3. Chest CT demonstrates expanded, poorly enhancing right middle lobe with internal consolidation/ground glass attenuation. Abrupt cut-off of right middle lobar bronchus is seen.
Brief Review
The incidence of lobar torsion is rare, occurring in 0.089-0.3% of patients following lobectomy. Lobar torsion is most commonly observed after thoracic surgery, and torsion of the right middle lobe after right upper lobectomy is the most common. It may also occur in traumatic or spontaneous condition.
Clinical findings include fever, tachycardia, dyspnea, and decreased breathing sounds, but these findings are not specific enough to make a confirmative diagnosis. Radiologic and bronchoscopic findings may be specific to make a correct diagnosis. Specific radiographic findings include rapid opacification or serial position change of the affected lobe. Post-operative follow-up with chest radiograph is most important for the correct diagnosis of a lobar torsion. On CT scan, the lobe will typically enhance poorly and have either ground glass attenuation/consolidation. The affected lobe can expand or undergo complete collapse. The bronchi and hilar vessels supplying the torsed lobe may exhibit cut-offs. The hilum can be displaced due to abnormal rotation. Lobar air-trapping with expansion of the twisted lobe owing to hemorrhagic engorgement and infarction may also be observed. Bronchoscopy may reveal an abnormally tight and obstructed orifice of the affected lobe.
In most cases, resection is performed due to irreversible ischemic change of the distorted lobe. In a few patients, simple de-torsion is carried out. If lobar torsion is suspected, exploratory thoracotomy should be performed without delay to prevent serious morbidity and mortality. To reduce the risk of lobar torsion, the right middle lobe can be fixed to the right lower lobe, especially if the fissure is well developed.
References
1. Child L, Ellis S and Francies O. Pulmoanry lobar torsion: a rare complication following pulmonary resection, but one not to mss. BJR Case Rep 2017; 2:20160010
2. Crijns K, Jansen F, van Straten A and van den Borne B. A pulmonary shadow after lobectomy: an unexpected diagnosis. The Netherlands Journal of Medicine 2012;70:232-235.
3. Chen C, Hung T, Chen T and Liu H. Torsion of right middle lobe after a right upper lobectomy. Journal of Cardiothoracic Surgery 2009;4:16-17
Keywords
Lung, Postoperative complication,

No. of Applicants : 126

▶ Correct Answer : 31/126,  24.6%
  • - Samsung Medical Center , Korea (South) HYUN JUNG YOON
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - NIMS, HYDERABAD , India BHASKAR K
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - McGill University Health Center , Canada Alexandre Semionov
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - Other , Korea (South) MARI A
  • - The Jikei university , Japan TAKU GOMI
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Kyungpook national university hospital , Korea (South) Nari Jung
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Other , Korea (South) SEONGSU KANG
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - , Korea (South) SEOYOUNG PARK
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Chonbuk National University Hospital , Korea (South) WEON JANG
  • - , Japan NAOMI YUASA
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - , Japan YUMI MAEHARA
  • - Chungbuk National University Hospital , Korea (South) YOUNGHUN JEON
  • - Teikyo University Hospital , Japan KAORU SUMIDA
▶ Correct Answer as Differential Diagnosis : 1/126,  0.8%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
▶ Semi-Correct Answer : 48/126,  38.1%
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Yonsei University,Severance Hospital , Korea (South) KYUNGSUN NAM
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Other , Korea (South) JIN YOUNG KIM
  • - Other , Korea (South) TAE SUN KANG
  • - , Korea (South) HANKYUL KIM
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Centre Hospitalier Regional de Lanaudiere , Canada Matthieu Storme
  • - , Korea (South) DAYOUNG KIM
  • - Ewha Womans University Medical Center , Korea (South) YOUNGSUN KO
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Private sector , Greece VASILIOS TZILAS
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - , China TINGTING WANG
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Myongji Hospital , Korea (South) KI EON KWON
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Chonbuk National University Hospital , Korea (South) SANGJIN PARK
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Seoul National University Hospital , Korea (South) JAE WON CHOI
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Chungbuk National University Hospital , Korea (South) CHANGHOON OH
  • - Chonbuk National University Hospital , Korea (South) AHN JI HOON
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - , Korea (South) KIM HAE JIN
  • - MD , India DEEPANDER SINGH RATHORE
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Hamamatsu university school of medicine , Japan YUKI HAYASHI
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • Top
  • Back

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

This website is optimized for IE 10 and above.