CTICasesLobar Torsion
Imaging findings
Chest radiograph and CT in a patient two weeks post right upper lobectomy demonstrate complete consolidation and medial displacement of the right middle lobe. CT shows the right middle lobe bronchus and pulmonary artery are abruptly cut off, with a twisting (torsion) of the lobar vascular pedicle by 180 degrees. The pulmonary veins remain patent. Urgent surgical exploration confirms right middle lobe torsion, which is viable and successfully detorsed and pexed.
Key takeaways
Lobar torsion is a rare, life-threatening surgical complication characterized by rotation of a lung lobe around its bronchovascular pedicle, most commonly affecting the right middle lobe after right upper lobectomy. It causes airway obstruction and venous congestion, leading to infarction and gangrene if untreated. Early diagnosis is key, showing consolidation, bronchial occlusion, and vascular twisting on CT.
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