Postoperative pulmonary torsion: report of a case and survey of the literature including spontaneous and posttraumatic torsion.

A case of postoperative torsion of the left upper lobe following thoracotomy for removal of a large mediastinal tumor is presented. Diagnosis was made on the sixth postoperative day by axial computerized tomography. At rethoracotomy the upper lobe, well delimited against the lower lobe by deep fissure, was found to be twisted by 180 degrees in clock-wise direction. It was hemorrhagically infarcted and had to be resected. The patient, a 37-year-old woman, made an uneventful recovery thereafter. In a recent epidemiological study in the United Kingdom it could be shown that postoperative torsion occurs more frequently than hitherto presumed. 35 of 117 thoracic surgeons responding to a questionnaire had observed this complication 36 times. In reviewing the literature for welldocumented cases, four cases of spontaneous, five of posttraumatic, and 17 cases of postoperative pulmonary torsion were found. Of these cases and the case reported 12 torsions occurred after partial lung resection and six following other thoracic operations. Especially the right middle lobe is endangered after upper lobectomy and should be fixed to the lower lobe during surgery. The outcome was fatal in 4 of the 18 cases. Prevention and treatment are discussed.