Middle lobe suffering due to malposition and 180° tilt of the 2 remaining lobes after right upper lobectomy. Issue 2 (22nd February 2023)

• Record Type: Journal Article
• Authors: Janet-Vendroux, Aurelie; Al Zreibi, Charbel; Reverdito, Guillaume; Arame, Alex; Badia, Alain; Masmoudi, Hicham; Messaoudi, Houssem; Le Pimpec-Barthes, Francoise
• Is Part Of: Interdisciplinary cardiovascular and thoracic surgery. Volume 36:Issue 2(2023)
• Publication Date: 2023-02-22
• Subjects: Middle lobe suffering -- Lobar malposition -- Right upper lobectomy -- Lung cancer -- Morbidity -- Postoperative
• DOI: 10.1093/icvts/ivad038
• Languages: English
• ISSNs: 2753-670X

Abstract

Abstract: Middle lobe (ML) suffering after right upper lobectomy (RUL) is rare but represents a major complication usually due to lobar torsion. We report 3 atypical consecutive cases of ML suffering due to malposition of the 2 remaining right lobes with a 180° tilt. All 3 female patients had surgery for non–small-cell carcinoma including RUL associated with radical hilar and mediastinal lymph node removal. Postoperative chest X-ray abnormalities appeared at days 1–3 respectively. The diagnosis of malposition of the 2 lobes was done on contrast-enhanced chest CT scan at days 7, 7 and 6, respectively. A reoperation for suspected ML torsion was required in all patients. Three repositionings of the 2 lobes and 1 middle lobectomy were performed. The postoperative courses were then uneventful, and the 3 patients were alive at a mean follow-up of 12 months. Before thoracic approach closure after RUL, systematic check of good positioning of the 2 reinflated remaining lobes is indispensable. It may prevent ML suffering secondary to 180° lobar tilt leading to whole pulmonary malposition. Abstract : Lobe torsion first described by Epplen and Jacobson [1] in 1930 corresponds to a twist of the lobe on its bronchovascular pedicle leading to ischaemia, infarction and potential fatal evolution.