Torsion of Lung

Epidemiology

  • Occurs after thoracotomy

Physiology

  • Torsion of the lung is defined as the parenchymal rotation of the whole lung on its bronchovascular pedicle
  • Torsion of the lung can lead to obliteration of both blood supplies to the lung with resultant ischemia and eventual gangrene of the lung
  • The ischemic lung is then associated with bronchorrhea, spillage of necrotic material into the opposite lung and alveolar hemorrhage

Clinical

It is recommended that the severely ischemic lung should be removed, because detorsion of the affected lung can lead to an ischemia-reperfusion injury causing grave sequelae. Detorsion may lead to profound hemodynamic consequences, including hypoxemia, hypotension, severe acidosis, and showering of the brain with emboli from the pulmonary veins.

Torsion should be suspected whenever opacification of a hemithorax appears on chest radiographs after thoracotomies, as it did in this patient.


References

  • Trotter MC, /McFadden PM, Ochsner JL. Spontaneous torsion of the right lung: a case report. Am Surg 1995; 61:306-309
  • Brath LK, Glauser FL, Zeilender S. The case of the disappearing mass. Chest 1996; 110:550-552
  • Goskowicz R, Harrell JH, Roth DM. Intraoperative diagnosis of torsion of the left lung after repair of a disruption of the descending thoracic aorta. Anesthesiology 1997; 87:164-166
  • Fisher CF, Ammar T, Silvay G. Whole lung torsion after a thoracoabdominal esophagogastrectomy. Anesthesiology 1997; 87:162-164
  • Fogarty JP, Dudek G. An unusual case of lung torsion. Chest 1995; 108:575-578