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Lung Torsion After Lung Transplantation

Evaluation with Helical CT

R. C. Gilkeson1, Paul Lange2 and Thomas J. Kirby3

1 Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, 11100 Euclid Ave., Cleveland, OH 44106.
2 Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, OH 44106.
3 Division of Cardiothoracic Surgery, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, OH 44106.



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  		Fig. 1A. —34-year-old man who underwent lung transplantation for silicosis and developed right lower lobe consolidation 3 days later. Axial helical CT scan obtained at level of bronchus intermedius reveals posterolateral displacement of right middle lobe bronchus (black arrow). Note narrowing of lower lobe bronchus (arrowhead). Also note prominent interlobular septal thickening in displaced right middle lobe (white arrow).

 


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  		Fig. 1B. —34-year-old man who underwent lung transplantation for silicosis and developed right lower lobe consolidation 3 days later. Axial helical CT scan with mediastinal window settings shows abnormal transposition of lower lobe pulmonary artery (long arrow) relative to narrowed inferior pulmonary vein (short arrow).

 


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  		Fig. 1C. —34-year-old man who underwent lung transplantation for silicosis and developed right lower lobe consolidation 3 days later. Axial helical CT scan inferior to A shows posterolateral displacement of right middle lobe (M). Consolidated right lower lobe (L) is anteromedially displaced. Posterior consolidation (arrow) is probably caused by venous congestion and infarction.

 


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  		Fig. 1D. —34-year-old man who underwent lung transplantation for silicosis and developed right lower lobe consolidation 3 days later. Sagittal multiplanar reconstruction shows abnormally reversed orientation of right major fissure (straight arrows). Note inferiorly displaced and congested superior segment of right lower lobe (curved arrow). A = anterior, P = posterior.

 


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  		Fig. 1E. —34-year-old man who underwent lung transplantation for silicosis and developed right lower lobe consolidation 3 days later. Bronchoscopic image (oriented to look down from head of patient) obtained at level of bronchus intermedius shows abnormal orientation of right middle lobe bronchus (M) (long arrow). Note expected location of right middle lobe orifice (short arrow). Lower lobe bronchus (L) is narrowed and erythematous. Bronchoscopic orientation: a = anterior, p = posterior, m = medial, l = lateral.

 

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