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Although clinical consequence of lobar torsion could be serious, differentiating it from bronchial kink is occasionally challenging.\nPresentation of case\nA 39-year old man with non-small cell lung cancer of cT1aN0M0 stage IA underwent right upper lobectomy. On postoperative day 1, we identified middle lobe atelectasis on the chest X-ray and performed bronchoscopy, which showed an obstruction of the right middle lobe bronchus without mucoid impaction. We injected air using a bronchoscope to the middle lobe, which re-expanded it. However, on postoperative day 2, chest X-ray showed a slightly collapsed and opacified middle lobe. Although enhanced computed tomography showed a patent middle lobe pulmonary artery, we noticed that a staple placed in the horizontal fissure was in contact with the lower lobe, implying the possibility of lobar torsion. Rethoracotomy on postoperative day 2 revealed a 240° clockwise rotation of the congested middle lobe. 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Computed tomography detection of stapled interlobar fissure facilitates diagnosing postoperative lobar torsion: A case report
http://hdl.handle.net/2241/00150658
http://hdl.handle.net/2241/001506580f0286a6-18a7-4f4c-86d7-1798dfe3c114
名前 / ファイル | ライセンス | アクション |
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IJSCR_41-86 (973.8 kB)
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Item type | Journal Article(1) | |||||
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公開日 | 2018-02-21 | |||||
タイトル | ||||||
タイトル | Computed tomography detection of stapled interlobar fissure facilitates diagnosing postoperative lobar torsion: A case report | |||||
言語 | ||||||
言語 | eng | |||||
資源タイプ | ||||||
資源 | http://purl.org/coar/resource_type/c_6501 | |||||
タイプ | journal article | |||||
著者 |
Yanagihara, Takahiro
× Yanagihara, Takahiro× Ichimura, Hideo× Kobayashi, Keisuke× Sato, Yukio |
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著者別名 |
佐藤, 幸夫
× 佐藤, 幸夫× 市村, 秀夫 |
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抄録 | ||||||
内容記述タイプ | Abstract | |||||
内容記述 | Introduction Atelectasis of the right middle lobe following right upper lobectomy may result from lobar torsion, bronchial kink, or impacted mucus plug. Although clinical consequence of lobar torsion could be serious, differentiating it from bronchial kink is occasionally challenging. Presentation of case A 39-year old man with non-small cell lung cancer of cT1aN0M0 stage IA underwent right upper lobectomy. On postoperative day 1, we identified middle lobe atelectasis on the chest X-ray and performed bronchoscopy, which showed an obstruction of the right middle lobe bronchus without mucoid impaction. We injected air using a bronchoscope to the middle lobe, which re-expanded it. However, on postoperative day 2, chest X-ray showed a slightly collapsed and opacified middle lobe. Although enhanced computed tomography showed a patent middle lobe pulmonary artery, we noticed that a staple placed in the horizontal fissure was in contact with the lower lobe, implying the possibility of lobar torsion. Rethoracotomy on postoperative day 2 revealed a 240° clockwise rotation of the congested middle lobe. Therefore, we performed simple detorsion. The patient was discharged 10 days after rethoracotomy without further adverse events. Discussion In our case, patency of the pulmonary artery and temporary improvement of the atelectasis using a bronchoscopic aeration maneuver could not rule out the possibility of lobar torsion. Conclusion The position of the staple placed on the interlobar fissure should be evaluated using computed tomography in postoperative middle lobe atelectasis. If the aeration maneuver for middle lobe atelectasis using bronchoscope fails, rethoracotomy should be considered. |
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書誌情報 |
International journal of surgery case reports 巻 41, p. 86-88, 発行日 2017-10 |
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ISSN | ||||||
収録物識別子タイプ | ISSN | |||||
収録物識別子 | 22102612 | |||||
PubMed番号 | ||||||
識別子タイプ | PMID | |||||
関連識別子 | 29055239 | |||||
DOI | ||||||
識別子タイプ | DOI | |||||
関連識別子 | 10.1016/j.ijscr.2017.10.013 | |||||
権利 | ||||||
権利情報 | © 2017 The Authors. | |||||
権利 | ||||||
権利情報 | Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ) | |||||
著者版フラグ | ||||||
値 | publisher | |||||
出版者 | ||||||
出版者 | Elsevier |