대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Torsion of RML with Infarction

Radiologic Findings

- CT scanogram shows a large increased density occupying right upper and mid-lung zone. Considering the past medical history of right upper lobectomy, the increased density suggests volume-expanding consolidation in right middle lobe (RML).

- Contrast-enhanced chest CT scans show RML consolidation.
Two chest tubes were inserted in right hemithorax for drainage of pleural effusion.
Air bronchogram is not seen within RML consolidation, suggesting proximal airway obstruction.
The stem bronchus of RML is obliterated.
Although tissue contrast is high enough, no definitely enhancing pulmonary artery is seen within RML consolidation.

- Lobar torsion of RML with infartion was found during emergency operation (RML lobectomy).

Brief Review

- Torsion of the lung, although relatively rare, can occur under three sets of circumstances:
i) spontaneously, usually in association with some other pulmonary abnormality;
ii) following traumatic pneumothorax; and
iii) as a complication of thoracic surgery.

- Felson (1) analyzed nine cases of pulmonary torsion.

The radiographic findings are

a collapsed or consolidated lobe that occupies an unusual position;
hilar displacement in a direction inappropriate for that lobe;
alteration in the normal position and sweep of the pulmonary vasculature;
rapid opacification of an ipsilateral lobe following trauma or thoracic surgery;
marked change in position of an opacified lobe on sequential radiographs;
bronchial cutoff with no evidence of a mass; or
lobar air trapping.

- Mortality is high if the torsion goes unrecognized and surgical fixation is delayed.

References

1. Felson B. Lung torsion: radiographic findings in nine cases. Radiology 1987 Mar;162(3):631-8

Keywords

Lung, Iatrogenic lung disease, Postoperative complication,