An Unexpected Twist: Lower Lobe Torsion After Left Upper Lobectomy—A Case Report

Lower lobe torsion after lobectomy is a rare complication, and torsion of the left lower lobe after a left upper lobectomy is rarer still. We describe a 69-year-old man with left upper lobe adenocarcinoma who, after neoadjuvant chemoimmunotherapy, negative mediastinoscopy samples, and a negative intraoperative frozen section of the aortopulmonary window node, underwent robotic left upper lobectomy with mediastinal lymph node dissection. On postoperative day 3, chest radiography showed left lower lobe opacification, and computed tomography and bronchoscopy confirmed torsion with complete bronchial occlusion, and thoracotomy confirmed torsion. Emergent thoracotomy revealed a twisted, ischemic lower lobe, which was detorsed and secured to the diaphragm. The lobe remained congested, and follow-up CT showed evolving necrosis and a loculated pleural collection prompting completion pneumonectomy. He remains without evidence of recurrence at 26 months. Persistent congestion after detorsion warrants concern for incomplete recovery of lobar perfusion despite initial clinical stability.