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Stern J, Khalil A, Roussel A, P M. WHOLE-LUNG torsion following bilateral lung transplant, a rare complication: A case report. Heliyon 2024; 10:e31491. [PMID: 38831818 PMCID: PMC11145471 DOI: 10.1016/j.heliyon.2024.e31491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
Whole lung torsion following bilateral lung transplant is a rare complication. This case report describes the diagnostic difficulties and consequences in a 59 year old patient. This study also includes a brief description of other cases in the literature.
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Affiliation(s)
- J. Stern
- Department of Anesthesiology and Critical Care Medecine, Bichat-Claude Bernard University Hospital, Paris, France
| | - A. Khalil
- Department of Radiology, Assistance Publique Hopitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - A. Roussel
- Department of Thoracic and Vascular Surgery, Assistance Publique Hopitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Montravers P
- Department of Anesthesiology and Critical Care Medecine, Bichat-Claude Bernard University Hospital, Paris, France
- Inserm UMR 1152, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
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2
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Ghosh S, Grewal HS, Johnston D, Mehta AC. Acute Dyspnea After Lung Transplantation. Chest 2022; 162:e169-e172. [DOI: 10.1016/j.chest.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 11/07/2022] Open
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Loor G, Mattar A, Schaheen L, Bremner RM. Surgical Complications of Lung Transplantation. Thorac Surg Clin 2022; 32:197-209. [PMID: 35512938 DOI: 10.1016/j.thorsurg.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lung transplantation is a life-saving intervention and the most effective therapy for select patients with irreversible lung disease. Despite the effectiveness of lung transplantation, it is a major operation with several opportunities for complications. For example, recipient and donor factors, technical issues, early postoperative events, and immunology can all contribute to potential complications. This article highlights some of the key surgery-related complications that can undermine a successful lung transplantation. The authors offer their expert opinion and experience to help practitioners avoid such complications and recognize and treat them early should they occur.
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Affiliation(s)
- Gabriel Loor
- Department of Surgery and Baylor Lung Institute, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030, USA; Division of Cardiothoracic Transplantation and Circulatory Support, Texas Heart Institute, 6720 Bertner Avenue Suite C355K, Houston, TX 77030, USA.
| | - Aladdein Mattar
- Department of Surgery and Baylor Lung Institute, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030, USA
| | - Lara Schaheen
- Norton Thoracic Institute, St. Joseph's Medical Center, 500 W Thomas Rd Ste 500, Phoenix, AZ 85013, USA; Creighton University School of Medicine-Phoenix Regional Campus, 350 W. Thomas Rd, Phoenix, AZ 85013, USA
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Medical Center, 500 W Thomas Rd Ste 500, Phoenix, AZ 85013, USA; Creighton University School of Medicine-Phoenix Regional Campus, 350 W. Thomas Rd, Phoenix, AZ 85013, USA
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Liu D, Nagle SK, Kleedehn MG. Left upper lobe and lingula torsion after transplantation of single lung with complete major and minor fissures: A case report. Clin Imaging 2022; 84:79-83. [PMID: 35151130 DOI: 10.1016/j.clinimag.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Native lung torsion is rare and torsion in a lung transplant is even rarer. CASE PRESENTATION Here we report a case of left upper lobe (LUL) and lingula torsion in a patient with a unilateral left lung transplantation. The transplant was complicated by a graft with a short pulmonary artery cuff, which required significant vascular reconstruction and manipulation. Additionally, the graft had complete left major and minor fissures, which are documented risk factors for torsion. After 24 h postoperatively, the patient failed to wean off ventilation. The patient was worked up with bronchoscopy, a computed tomography (CT), and a CT angiogram (CTA). A CT without intravenous (IV) contrast showed the findings suggestive of torsion of the LUL and lingula and the CTA confirmed the diagnosis. Immediate re-exploration was performed for detorsion to preserve the vitality of the allograft. Following the failed detorsion, the patient had re-transplantation of the left lung with good results. CONCLUSION Lung torsion should be watched for in patients with major risk factors like complete fissure. CT and/or CTA are effective tools to confirm the diagnosis.
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Affiliation(s)
- Daniel Liu
- University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53705, United States.
| | - Scott K Nagle
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53705, United States.
| | - Mark G Kleedehn
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53705, United States.
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Restrepo CS, Vargas D, Martinez-Jimenez S, Ocazionez D. Post-operative imaging of pulmonary vessels. Cardiovasc Diagn Ther 2018; 8:362-371. [PMID: 30057882 DOI: 10.21037/cdt.2018.03.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Complications following cardiothoracic surgery are responsible for prolonged hospital stay, increase cost in patient care and increased morbidity and mortality. Vascular complications in particular are significant contributors to poor patient outcome due to either hemorrhage or thrombosis and ischemia. Evaluation of vascular complications in the postoperative patient requires a rapid and reliable imaging approach. Vascular complications after cardiothoracic surgery include pulmonary artery thrombosis, pseudoaneurysm, pulmonary vein thrombosis, vascular fistulas, stenosis and infarction. Multidetector CT (MDCT), often the imaging modality of choice, offers a one-stop-shop capability to visualize the entire cardiothoracic vasculature, airways, lung parenchyma, mediastinum and chest wall with excellent temporal and spatial resolution.
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Affiliation(s)
- Carlos Santiago Restrepo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Daniel Vargas
- Department of Radiology, University of Colorado in Denver, Denver, CO, USA
| | | | - Daniel Ocazionez
- Department of Radiology, University of Texas Health Science Center at Houston, Houston, TX, USA
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David A, Liberge R, Corne F, Frampas E. Whole-lung torsion complicating double lung transplantation: CT features. Diagn Interv Imaging 2016; 97:927-8. [PMID: 27421675 DOI: 10.1016/j.diii.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 05/22/2016] [Accepted: 05/23/2016] [Indexed: 12/01/2022]
Affiliation(s)
- A David
- Service de radiologie centrale, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France.
| | - R Liberge
- Service de radiologie centrale, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France.
| | - F Corne
- Service de pneumologie, CHU de Nantes, boulevard Professeur-Jacques-Monod, 44800 Saint-Herblain, France.
| | - E Frampas
- Service de radiologie centrale, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France.
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Tejwani V, Panchabhai TS, Kotloff RM, Mehta AC. Complications of Lung Transplantation. Chest 2016; 149:1535-45. [DOI: 10.1016/j.chest.2015.12.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 11/16/2015] [Accepted: 12/11/2015] [Indexed: 01/30/2023] Open
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Cox CS, Decker SJ, Rolfe M, Hazelton TR, Rojas CA. Middle Lobe Torsion after Unilateral Lung Transplant. J Radiol Case Rep 2016; 10:15-21. [PMID: 27761176 DOI: 10.3941/jrcr.v10i5.2761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lobar torsion is well documented after pneumonectomy, but is very rare after lung transplant. To the best of our knowledge, this is the twelfth reported case of lobar torsion after lung transplant. In our case, bronchoscopies and chest radiographs were inconclusive; however, CT scan clearly demonstrated findings consistent with right middle lobe torsion. We review the literature and discuss the epidemiology, clinical presentation, imaging features, and treatment considerations for this condition. We also propose that if a clinical picture could be secondary to torsion and bronchoscopies and chest x ray are inconclusive that a CT scan should be obtained as soon as possible since early recognition increases the likelihood of being able to successfully detorse the lung and avoid lobectomy.
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Affiliation(s)
- Chad S Cox
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Summer J Decker
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Mark Rolfe
- Department of Pulmonology and Critical Care, Tampa General Hospital, Tampa, USA
| | - Todd R Hazelton
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Carlos A Rojas
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, USA
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Left Lung Torsion: Complication of Lobar Resection for an Early Stage Lung Adenocarcinoma. Case Rep Crit Care 2016; 2016:9240636. [PMID: 27293912 PMCID: PMC4886097 DOI: 10.1155/2016/9240636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/24/2016] [Indexed: 11/28/2022] Open
Abstract
Lobar torsion is a fatal but fortunately rare occurrence following lung resection. Early clinical signs and radiographic features may be nonspecific resulting in diagnostic delay. A high index of suspicion is vital for early diagnosis and intervention to avoid further parenchymal necrosis and deadly gangrene. We report a case of left lower lobe torsion in a 76-year-old female following elective upper lobectomy for underlying lung adenocarcinoma. Diagnosis was made following highly suggestive radiographic findings prompting bronchoscopy and revision thoracotomy. An emergency detorsion failed to restore lung viability and was followed by completion pneumonectomy. The patient recovered and was discharged on the seventh postoperative day.
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