Overview
Lobar torsion is a rare and severe complication following thoracic surgery, characterized by rotation of the bronchovascular pedicle leading to airway obstruction, vascular compromise, and potential lobar ischemia or infarction 12.Diagnosis
Early progressive lobar opacity without atelectasis on chest radiographs
Computerized tomography (CT) scans for detailed imaging
Bronchoscopy to assess airway patency and identify vascular compromise
Rapid clinical suspicion based on postoperative imaging changes 2Management
Immediate exploratory thoracotomy for diagnosis and treatment
Untwisting of the pedicle to restore normal lung position
Removal of serosanguinous fluid from airways post-untwisting
Consider tracheostomy for frequent suction if attempting to salvage the lobe 2
Sacrifice of the injured parenchyma if diagnosis is delayed 2Special Populations
No specific details provided regarding pregnancy, pediatrics, elderly, or comorbidities in the given abstracts 12Key Recommendations
Perform immediate exploratory thoracotomy upon suspicion of lobar torsion to prevent irreversible damage (Evidence: Weak) 2
Untwist the bronchovascular pedicle promptly to restore blood flow and airway patency (Evidence: Weak) 2
Consider tracheostomy for patients where saving the affected lobe is attempted to manage airway secretions (Evidence: Weak) 2References
1 Mariolo AV, Seguin-Givelet A, Gossot D. Fatal Stroke After Reoperation for Lobar Torsion. The Annals of thoracic surgery 2020. link
2 Larsson S, Lepore V, Dernevik L, Nilsson F, Selin K. Torsion of a lung lobe: diagnosis and treatment. The Thoracic and cardiovascular surgeon 1988. link