Necrotizing pneumonitis caused by postoperative pulmonary torsion

Pulmonary torsion is an adverse event with a reported incidence of 0.089-0.4%. It may occur spontaneously, after trauma but most often as a rare complication after pulmonary surgery. We describe a case of lobar torsion of the left upper lobe after lobectomy of the left lower lobe, which resulted in a necrotizing pneumonitis with fever, hemoptysis and weight loss. A completion pneumonectomy was performed after which the patient recovered well. A review of the literature shows that a delay in diagnosis and treatment of this rare complication can have catastrophic consequences. Surgery is the treatment of choice since sparing of the lobe is hardly ever possible due to the irreversible ischemic changes. Detorsion, instead of resection, may lead to fatal complications. Although infrequent, one should be aware of lobar torsion and the necessity for immediate re-intervention.