Lobar torsion after thoracoscopic upper bilobectomy: report of a case

Dario Amore, Antonio Molino, Dino Casazza, Umberto Caterino, Marcellino Cicalese, Roberto Scaramuzzi, Davide Di Natale, Albina Palma, Pasquale Imitazione, Carlo Curcio


Lung or lobar torsion is a very rare condition that can cause serious complications if missed or untreated. We report a case of a 72-year-old man undergoing video-assisted thoracoscopic upper bilobectomy for treatment of lung cancer. On the first postoperative day radiographic and bronchoscopic findings suggested lobar torsion and then exploratory thoracotomy was carried out within 24 hours of the initial procedure performing simple detorsion and not completion pneumonectomy for various reasons: absence of pulmonary necrosis, incomplete rotation of the bronchovascular pedicle, patient’s inability to functionally tolerate a pneumonectomy. Unfortunately the patient didn’t show clinical and radiological improvement, during the postoperative period, and he died 12 days later due to cardiorespiratory complications. This case report highlights the need for prompt intervention in patients with lobar torsion within a few hours from the onset of the phenomenon. At the same time it highlights the possibility of fatal outcome in patients unable to functionally tolerate further lung resection. To the best of our knowledge, this is the first report of lobar torsion following video-assisted thoracoscopic upper bilobectomy.