Left lower lobe torsion after upper lobectomy.

A 61-year-old woman with adenocarcinoma of the left upper lobe of the lung and no hilar or mediastinal lymphadenopathy had a video-assisted thoracoscopic left upper lobectomy. A week after operation, the patient developed fever, cough, and shortness of breath. Chest radiograph showed opacified left hemithorax with abnormal air lucency in the upper zone (Fig 1). She was treated for chest infection. Bronchoscopy revealed a swollen left lower lobe bronchial orifice, although the bronchoscope could still pass through. The left upper lobe bronchial stump was intact. Contrast-enhanced computed tomographic (CT) scan was performed to exclude complications in view of the slow clinical improvement. Computed tomography showed abrupt termination and complete obstruction of the left lower lobe bronchus at its origin (Fig 2). The left lower lobe was situated at an abnormally high position in the thorax, which also showed areas of poor contrast enhancement and cavity formation. To further assess the status of the hilar structure, multiplanar reformation and volume rendering were performed at a workstation. On the volume-rendered image, the patent’s left lower lobe pulmonary artery showed an anticlockwise twist (viewed from the left side of the patient) and had an abnormal cranial course (Fig 3). The diagnosis of left lower lobe torsion Left lower lobe torsion after upper lobectomy P I C T O R I A L M E D I C I N E