2024 Asia Conference on Lung Cancer (ACLC) - Poster & ePosters-PP02.21

PP02.21 - Yui Kaburaki

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The document presents two cases of early torsion of the middle lobe in patients following lung tumor surgery, a rare complication with an occurrence rate between 0.089% and 0.3%. The first case involved a 50-year-old woman with no history of smoking or significant medical history. Post-surgery, her right middle lobe (RML) showed signs of torsion, like atelectasis, narrowing of the pulmonary artery and vein, and discoloration, prompting a completion middle lobectomy. The pathological examination revealed alveolar wall degeneration and thrombosis in the pulmonary vessels.<br /><br />The second case involved a 72-year-old woman with a history of COPD and smoking. After VATS right upper lobectomy, her RML also developed torsion with similar symptoms: atelectasis and edematous surface with discoloration. Pathological findings indicated congestive lung with infarction and necrosis. She also underwent a completion middle lobectomy after the torsion was detected. Her recovery was complicated by the onset of Takotsubo cardiomyopathy, delaying her discharge.<br /><br />The document emphasizes the importance of prompt contrast-enhanced CT scans when postoperative chest X-rays indicate atelectasis. Such findings could suggest pulmonary artery or vein interruption, necessitating immediate surgical evaluation of the affected lung. The authors advise against detorsion of the middle lobe if discoloration and significant edema are observed, due to potential risks like cerebral embolism and ARDS from ischemia-reperfusion injury. Thus, immediate resection without detorsion is recommended under these conditions. The report underlines the difficulty in diagnosing lung torsion solely based on clinical results or vital signs.

Keywords

lung torsion

middle lobe

postoperative complication

lung tumor surgery

atelectasis

CT scan

completion middle lobectomy

ischemia-reperfusion injury

Takotsubo cardiomyopathy

pulmonary artery interruption