Lobar torsion complicating bilateral lung transplantation

• Published in: The Journal of heart and lung transplantation Vol. 22; no. 1; pp. 102 - 106
• Main Authors: Grazia, Todd J, Hodges, Tony N, Cleveland, Joseph C, Sheridan, Brett C, Zamora, Martin R
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2003; Elsevier Science
• Subjects: Biological and medical sciences; Humans; Lung Diseases - etiology; Lung Diseases - surgery; Lung Transplantation; Male; Medical sciences; Middle Aged; Postoperative Complications - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Torsion Abnormality - etiology; Torsion Abnormality - surgery; Left; Lung; Cardiovascular disease; Bilateral; Transplantation; Homotransplantation; α1-Antitrypsin; Infiltrate; Consolidation; Hypoxemia; Surgery; Graft; Endoscopy; Torsion; WHO; Bronchoscopy; Human; Postoperative; Oxygen; Radiodiagnosis; Respiratory disease; Acute; Deficiency; Thorax; Pulmonary hypertension; Case study; Radiography; Treatment; Day
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/S1053-2498(02)00487-4

We report a case of left lower lobe torsion in a patient who had undergone bilateral lung transplantation for α 1-antitrypsin deficiency. The patient experienced acute pulmonary hypertension and hypoxemia on post-operative Day 3 and the chest X-ray showed bilateral alveolar infiltrates and a new focal consolidation of the left lower lobe. Fiberoptic bronchoscopy showed complete obstruction of the left lower lobe bronchus and abnormal rotation of the left upper lobe bronchus suggesting torsion, which was confirmed by pulmonary angiography and ultimately at thoracotomy. The possibility of acute lobar torsion should be considered in lung transplant recipients who demonstrate evidence of acute respiratory insufficiency in the early post-operative period.