2025 Volume 39 Issue 1 Pages 18-24
A 68-year-old man underwent thoracoscopy-assisted right lower lobectomy and lymph node dissection. The chest tube was removed on the second post-operative day, and a constriction sound appeared in the right anterior chest on the third day. CT showed stenosis of the right upper lobe and middle lobe bronchi, as well as infiltrative shadows and ground-glass opacities in the right upper lobe, and the upper lobe was located dorsally and the middle lobe ventrally. In addition, the staple line of the middle lobe when the middle and lower lobes were separated was present between the upper and middle lobes. Bronchoscopy revealed mild stenosis at the right upper and middle lobe bronchial entrances, and we suspected middle lobe torsion, and reoperated. The middle lobe was twisted 90 degrees clockwise around the bronchus, and the upper lobe was located dorsally and the middle lobe ventrally. We diagnosed middle lobe torsion, and the torsion was removed. It is important to be aware that middle lobe torsion can occur even after lower lobe resection, and that in middle lobe torsion, abnormalities may be found in areas other than the middle lobe. In addition, focusing on the position of the staple line is useful for diagnosis, and contrast-enhanced CT examination is useful for determining the treatment plan.
