Bilateral whole-lung torsion after bilateral lung transplantation

A 61-year-old man with severe idiopathic pulmonary fibrosis developed subacute, bilateral lung torsion after uneventful double lung transplantation. Unenhanced chest computed tomography demonstrated abnormal orientations of both lung allografts with narrowing of the main and lobar bronchi. Surgical reexploration confirmed clockwise rotation of the left lung allograft and counterclockwise rotation of the right lung allograft around their respective hilar axes, as viewed from the ipsilateral axilla. Our case illustrates the value of computed tomography imaging in identifying abnormal lung orientation and bronchial narrowing, and we discuss the potential mechanism for this unusual postoperative event.