Lobar torsion after pulmonary resection: Presentation and outcome

David G. Cable, Claude Deschamps, Mark S. Allen, Daniel L. Miller, Francis C. Nichols, Victor F. Trastek, Peter C. Pairolero

Research output: Contribution to journalArticlepeer-review

102 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1091-1093
Number of pages3
JournalJournal of Thoracic and Cardiovascular Surgery
Volume122
Issue number6
DOIs
StatePublished - Dec 1 2001
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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