Lung and lobe torsion: a narrative review

Pulmonary torsion is a rare, life-threatening condition characterized by the rotation of a lung or its lobe around the bronchovascular pedicle, leading to necrosis. This review aims to summarize the current literature on pulmonary torsion, assess current understanding and identify gaps in the knowledge.

This narrative review was conducted using PubMed, Google Scholar, Cochrane Library, Scopus, and Embase to identify articles related to pulmonary and lobar torsion. The search was limited to articles published between 1985 and 2024. A total of 92 articles were initially identified as relevant, of which 61 were included. Articles in English, French, Spanish, German, and Japanese were considered, with Google Translate used for some Japanese-language articles.

We identified 125 cases of lung torsion, 91 of which occurred post-operatively. These cases of torsion occurred mainly after an upper lobe resection and concerned mainly the right middle lobe, followed by the left lower lobe. We also found that our level of current knowledge of lung torsion is weak, in terms of physiological comprehension and peri-operative prevention. The treatment is usually radical, with a lobectomy, and the mortality is high. A rapid diagnosis and treatment is mandatory to reduce morbidity and mortality.

Pulmonary torsion is a rare, however life-threatening condition. The incidence is low, with a high misdiagnosis rate. Radiological imaging is crucial for diagnosis. Treatment includes detorsion and lobectomy. Although no clear surgical procedures are highlighted to prevent such complications, the education of the medical teams can enhance the prompt diagnosis and thus treatment of pulmonary torsion to reduce morbidity and mortality.