Clinical ramifications of bronchial kink after upper lobectomy

Bronchial kink is caused by upward displacement of the remaining lower lobe of the lung after upper lobectomy, which can cause an intractable cough or shortness of breath. However, bronchial kink is often overlooked because of the difficulty in the simultaneous diagnosis of bronchial curvature and narrowing.

Screening for bronchial kink with three-dimensional computed tomography (CT)-based bronchography was done on 50 patients who had undergone hemilateral upper lobectomy for cancer. Bronchial kink was confirmed if there was airway angulation and resultant stenosis exceeding 80%. We compared postoperative changes in spirometry-based ventilatory capacity with CT-based functional lung volume (FLV) in patients with and without bronchial kink.

Bronchial kink was confirmed in 21 patients (42%). Postoperative FLV and ventilatory capacity were significantly greater in patients without than in those with bronchial kink (p<0.05 for both measures). Postoperative FLV and ventilatory capacity were also significantly greater than the estimated postoperative values for both measures in patients without bronchial kink (both, p<0.05), representing favorable compensatory adaptation of the remaining lung, whereas this was not the case in patients with bronchial kink (both, p>0.1). Patients with bronchial kink complained more often than those without bronchial kink of an intractable cough and shortness of breath (76% vs 21%, respectively, p<0.01).

Bronchial kink after upper lobectomy is a common and functionally unfavorable condition that can exacerbate postoperative shortness of breath. Computed tomography-based bronchography is a useful tool in screening for bronchial kink. Strategies for preventing bronchial kink should be explored in the clinical setting.