Pulmonary torsion complication after VATS Right up Lobectomy for Early-Stage Lung Cancer—A Two-Case Report from the National Lung Hospital

Background: Pulmonary lobar torsion is a rare but potentially fatal complication following lobectomy. Right upper lobectomy is the most common predisposing procedure, with the right middle lobe being most frequently affected because of its increased mobility after loss of its anatomical attachment to the upper lobe. Clinical manifestations are often nonspecific, which may lead to delayed diagnosis and serious consequences. Case presentation: We report two patients who underwent video-assisted thoracoscopic right upper lobectomy with systematic lymph node dissection for early-stage non-small cell lung adenocarcinoma. During the early postoperative period, both patients developed progressively increasing right-sided pulmonary opacity accompanied by nonspecific clinical deterioration. Contrast-enhanced computed tomography demonstrated consolidation of the right middle lobe with reduced enhancement, tapering and abrupt cutoff of the middle lobe bronchus, and a small, abnormally twisted middle lobe pulmonary artery. Bronchoscopy confirmed obstruction and deformation of the middle lobe bronchial lumen. Surgical re-exploration revealed torsion of the right middle lobe around its bronchovascular pedicle with hemorrhagic infarction; completion middle lobectomy was therefore performed in both patients. Histopathological examination confirmed hemorrhagic infarction. Both patients recovered uneventfully and were discharged 7 days after reoperation. Conclusion: Lobar torsion should be considered in any patient who develops an unexplained pulmonary opacity or clinical deterioration after pulmonary lobectomy. It most commonly involves the right middle lobe following right upper lobectomy. Early diagnosis using contrast-enhanced computed tomography and bronchoscopy, followed by timely surgical re-exploration, is crucial for preventing severe complications. Prophylactic fixation of the remaining lobe should be considered, particularly in patients at high risk of postoperative lobar torsion.