What the study found
Middle lobe torsion after pulmonary lobectomy is described as an uncommon but potentially life-threatening postoperative complication. In two cases after right upper lobectomy, persistent postoperative atelectasis and unclear initial bronchoscopy findings led to repeated bronchoscopy and contrast-enhanced computed tomography, which enabled early diagnosis and timely surgery.
Why the authors say this matters
The authors conclude that lobar torsion should be considered when postoperative atelectasis persists despite preserved oxygenation. They also state that systematic imaging and anesthetic strategies adapted to airway and vascular challenges are important for optimizing perioperative outcomes in this rare condition.
What the researchers tested
The report describes two cases of right middle lobe torsion after right upper lobectomy. For reoperation, the anesthetic plan focused on lung isolation with selected double-lumen tubes, anticipating airway mucosal edema, and close hemodynamic monitoring during release of the torsion.
What worked and what didn't
In the first case, irreversible torsion and poor perfusion led to middle lobectomy. In the second case, preserved parenchymal enhancement allowed detorsion with lobar fixation. In both cases, oxygenation and hemodynamics remained acceptable during anesthesia, and there was no evidence of reperfusion-related instability.
What to keep in mind
This summary is limited to two case reports, so it does not establish how often these findings occur. The abstract does not provide detailed long-term outcomes, and it does not describe a control group or compare different management strategies.
Key points
- Two cases of right middle lobe torsion occurred after right upper lobectomy.
- Persistent postoperative atelectasis with unclear initial bronchoscopy prompted repeated bronchoscopy and contrast-enhanced CT.
- One case required middle lobectomy because torsion was irreversible and perfusion was compromised.
- The other case was treated with detorsion and lobar fixation because parenchymal enhancement was preserved.
- Both patients had acceptable oxygenation and stable hemodynamics during anesthesia, with no reperfusion-related instability.
Disclosure
- Research title:
- Middle lobe torsion was diagnosed early after right upper lobectomy
- Authors:
- Mai Akazawa, Yasuhiko Imashuku, Yojiro Tsujimoto, Risa Katsuyama, Yoshihisa Fujino
- Institutions:
- Shiga University of Medical Science, Fukuoka Higashi Medical Center, National Hospital Organization
- Publication date:
- 2026-02-24
- OpenAlex record:
- View
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