Video-Assisted Thoracoscopic Conservative Repair of Postoperative Lobar Torsion Mitsuaki Sakai, MD, PhD, Kou Kurimori, MD, Yusuke Saeki, MD, Shinsuke.

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Video-Assisted Thoracoscopic Conservative Repair of Postoperative Lobar Torsion Mitsuaki Sakai, MD, PhD, Kou Kurimori, MD, Yusuke Saeki, MD, Shinsuke Kitazawa, MD, Keisuke Kobayashi, MD, Kesato Iguchi, MD, PhD, Yukio Sato, MD, PhD The Annals of Thoracic Surgery Volume 98, Issue 5, Pages e119-e121 (November 2014) DOI: 10.1016/j.athoracsur.2014.07.080 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Computed tomography at the time of middle lobe torsion onset, which reveals the sharply shaped occlusion of the pulmonary vein and enhancement of the peripheral pulmonary artery (white asterisk). (B) Day 7 after repairing the torsion. The middle lobe is partially expanded, but a pulmonary vein thrombus is formed (white arrowhead). (C): Six months after the repair, the middle lobe is fully expanded, and the pulmonary vein thrombus has disappeared. (LA = left atrium; PA = pulmonary artery; RML = right middle lobe.) The Annals of Thoracic Surgery 2014 98, e119-e121DOI: (10.1016/j.athoracsur.2014.07.080) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A): The right middle lobe was twisted approximately 150 degrees counterclockwise (white arrowhead). (B) Massive serous bloody sputum was secreted into the airway immediately after detorsion. The sputum disappeared spontaneously after 1 h of continuous suction; thereafter, the orifice of the middle lobe bronchus appeared. (C) The surface color, elasticity, and compliance of the middle lobe improved after detorsion. (D) We attached the middle lobe to the lower lobe by over-and-over suture to avoid re-torsion. (RLL = right lower lobe; RML = right middle lobe.) The Annals of Thoracic Surgery 2014 98, e119-e121DOI: (10.1016/j.athoracsur.2014.07.080) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions