AlMutawa Yousef, Olaya Diana E, Huang Gao S, Kaminska Marta, Pressacco Josephine, Spicer Jonathan, Steinmetz Oren
Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada.
Respiratory Division, McGill University Health Centre, Montreal, Quebec, Canada.
EJVES Vasc Forum. 2023 Jun 2;60:8-11. doi: 10.1016/j.ejvsvf.2023.05.016. eCollection 2023.
Lobar torsion is a rare, challenging diagnosis that requires a high index of suspicion and prompt investigation and management. Detection and urgent fixation or lung resection are critical to avoid catastrophic sequelae of lung necrosis, bronchopleural fistulae, and death.
A case of lobar torsion following open repair of a type B aortic dissection and thoraco-abdominal aortic aneurysm in a patient with Marfan syndrome is presented. After a non-specific constellation of symptoms, the diagnosis was confirmed with computed tomography and bronchoscopic findings and the patient underwent detorsion and plication of a torted, yet viable, left upper lobe on post-operative day 6. The patient is currently being followed with serial imaging to follow a necrotic consolidation of the left upper lobe.
This was a case of lobar torsion in a patient with Marfan syndrome and the degree of connective tissue disease may have predisposed the patient to this rare surgical complication. The case presents a challenging dilemma due to the risks associated with exposing a synthetic aortic graft to a potentially infected space if lobar resection or a pneumonectomy was performed.
肺叶扭转是一种罕见且具有挑战性的诊断，需要高度的怀疑指数以及及时的检查和处理。进行检测并紧急固定或切除肺叶对于避免肺坏死、支气管胸膜瘘和死亡等灾难性后果至关重要。
本文报告了一例患有马凡综合征的患者，在接受B型主动脉夹层和胸腹主动脉瘤开放修复术后发生肺叶扭转的病例。在出现一系列非特异性症状后，通过计算机断层扫描和支气管镜检查结果确诊，患者在术后第6天接受了扭转但仍存活的左上肺叶的扭转复位和折叠术。目前正在对该患者进行系列影像学检查，以跟踪左上肺叶的坏死性实变情况。
这是一例马凡综合征患者发生肺叶扭转的病例，结缔组织疾病的程度可能使该患者易患这种罕见的手术并发症。由于如果进行肺叶切除或全肺切除，将合成主动脉移植物暴露于潜在感染空间会带来风险，该病例呈现出一个具有挑战性的困境。
