Abstract Introduction Lobar torsion is a rare but potentially serious complication following lobectomy, this usually involves the right middle lobe after right upper lobe lobectomy. The clinical presentation is nonspecific, making this a significant diagnostic challenge. Early identification is essential, as delayed diagnosis can result in ischemia, infarction of the affected lung leading to infection. This case highlights the importance of maintaining a high index of suspicion for lobar torsion in postoperative patients with unexplained lobar collapse. Case A 67-year-old male long-term smoker was found to have a 3cm right upper lobe (RUL) mass. Image guided bronchoscopy was consistent with right upper lobe adenocarcinoma. He subsequently underwent a right upper lobectomy. His immediate postoperative recovery was uneventful and was discharged home on the first postoperative day (POD) following chest tube removal. On the fourth POD, he presented to the emergency room for progressive dyspnea, he was hypoxic, and CT chest revealed a dense collapse of the RML with volume loss, without bronchial obstruction. Urgent flexible bronchoscopy confirmed a patent RML orifice but there was circumferential collapse of subsegmental bronchi without obstructive lesion or reversible causes thus concerning for lobar torsion. Saline instillation failed to restore distal airway patency. Thoracic surgery was emergently consulted and intraoperative evaluation confirmed RML torsion with ischemia. Despite careful intraoperative de-torsion, the lobe failed to regain viability, and RML lobectomy was performed which was well tolerated. Postoperatively, he received intravenous antibiotics for hospital-acquired pneumonia, chest tube drainage, and multimodal analgesia. He was successfully weaned to room air, tolerated regular diet, and discharged in stable condition after chest tube removal. Conclusion Right middle lobe torsion is a rare complication following RUL lobectomy due to increased lung mobility and disruption of supporting structures. The presentation mimics more common postoperative complications such as atelectasis or pneumonia; leading to diagnostic delay. Radiographic findings of lobar collapse without a clear etiology, in conjunction with inconclusive bronchoscopy, should prompt consideration of torsion. Early recognition and prompt surgical exploration are critical, as de-torsion may salvage viable lung tissue; however, resection is indicated if necrosis is evident. This case emphasizes the importance of maintaining a high index of suspicion for lobar torsion in patients with acute respiratory deterioration and unexplained lobar collapse after lobectomy. Prompt diagnosis and intervention with a multidisciplinary (pulmonology, radiology, and thoracic surgery) approach is imperative to prevent irreversible pulmonary injury. This abstract is funded by: None
Agudosi et al. (Fri,) studied this question.