CTICasesRetrocardiac Lung Herniation
Imaging findings
Chest CT in a patient post-bilateral heart and lung transplantation shows a surgical pneumothorax and chest tubes. In addition, the entire right lower lobe has herniated across the midline, passing behind the left atrium and in front of the esophagus into the left hemithorax. The bronchi and pulmonary vessels of the herniated lobe are intact and patent, and the lung remains viable.
Key takeaways
Retrocardiac lung herniation is a rare iatrogenic complication of combined heart-lung transplantation. Surgical mobilization of the heart and incision of the pulmonary ligaments create a mobile, wide-open retrocardiac space. Under the influence of mechanical ventilation and cardiac motion, the right lower lobe can slide across the midline into the left chest, requiring surgical reduction and muscle flap repair to prevent torsion.
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