Thoracotomy for Urgent Repair of Lung Torsion Identified as an Incidental Finding

We report a 68-year-old male with chronic obstructive pulmonary disease on home oxygen who presented with foot swelling and erythema, associated with a new right foot wound. He denied chest pain and overt shortness of breath at the time of his presentation. Initial chest radiography obtained during the evaluation raised concern for pneumothorax versus a large bulla. Computed tomography with intravenous contrast and computed tomography angiography revealed an expanding right lower lobe bulla extending into the upper lung zone, narrowing of the right bronchial tree, and abnormal right hilar vasculature orientation concerning for lung torsion. Bronchoscopy demonstrated compression of the right upper lobe bronchus and severe compression of the right middle and lower lobe bronchi. The right lower and middle lobes were detorsed, and the bullous right lower lobe tissue was removed by wedge resection. Test inflation demonstrated satisfactory expansion, and there were no intraoperative complications. The postoperative course was complicated by a pleural effusion requiring decortication two weeks postoperatively, after which the patient recovered well. This case highlights how lung torsion may be identified incidentally and require urgent operative repair despite an inconspicuous respiratory presentation.