CTICasesPost-Operative Pulmonary Lobar Torsion
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Imaging findings
Post-operative radiograph following a left upper lobectomy shows complete opacification of the remaining left hemithorax. Non-contrast CT chest reveals a giant, edematous, "boggy," non-aerated left lower lobe filling the hemithorax without significant volume loss. Additional findings include abrupt tapering and occlusion of the left lower lobe bronchus and narrowing of the inferior pulmonary vein, with peripheral ground-glass opacities resembling a hemorrhagic infarction.
Key takeaways
Lobar torsion is a rare, life-threatening post-operative complication that occurs when a remaining lung lobe rotates on its bronchovascular pedicle, leading to complete airway obstruction and vascular compromise. It is favored by complete interlobar fissures and mobilization/resection of the pulmonary ligament. Rapid diagnosis is essential, as delay results in hemorrhagic gangrene requiring emergency completion pneumonectomy.
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