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J Thorac Cardiovasc Surg 2001;122:1091-1093
© 2001 The American Association for Thoracic Surgery

General Thoracic Surgery (GTS)

Lobar torsion after pulmonary resection: Presentation and outcome

From the Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minn.

Presented in part at the 13th Annual Meeting of The European Association for Cardio-Thoracic Surgery, Glasgow, United Kingdom, September 8, 1999.

Received for publication March 26, 2001. Revisions requested April 15, 2001; revisions received June 1, 2001. Accepted for publication June 5, 2001. Address for reprints: Claude Deschamps, MD, Division of General Thoracic Surgery, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905 (E-mail: deschamps. claude{at}mayo.edu).

Abstract

Objective: We reviewed our experience on postoperative lobar torsion.
Methods: Between January 1972 and January 1998, 7887 patients underwent pulmonary resection at our institution. Seven (0.089%; 4 women and 3 men; median age, 68 years) patients required surgical reintervention for lobar torsion.
Results: The indications for pulmonary resection were non–small cell carcinoma in 5 patients, lymphoma in 1 patient, and metastatic prostate carcinoma in 1 patient. The right upper lobe was resected in 3 patients, the left lower lobe in 2 patients, and the right middle and right lower lobe in 1 patient each. Postoperative radiographs demonstrated pulmonary infiltrates and volume loss in 5 patients and complete opacification in 2 patients. The median white blood cell count was 10.6 x 10⁹ cells/L (range, 9.3-14.9 x 10⁹ cells/L), and the median peak temperature was 38.4°C (range, 37.8°C-40.2°C) during the first 48 hours postoperatively. The diagnosis of lobar torsion was made a median of 10 days (range, 2-14 days) after the initial operation; 4 patients underwent completion pneumonectomy, and 3 had lobectomy. Median hospitalization was 24 days and ranged from 10 to 56 days. There were no postoperative deaths. Complications after reoperation included respiratory failure in 2 patients, atrial arrhythmia in 2 patients, and empyema, urinary tract infection, and a transient ischemic attack in 1 patient each.
Conclusions: Lobar torsion represents a difficult diagnostic dilemma in the early postoperative period after pulmonary resection. A high index of suspicion is necessary to avoid a delay in treatment. Late diagnosis results in further pulmonary resection and prolonged hospitalization in the majority of cases.

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