Peripheral Pulmonary Torsion in the Emphysematous Lingular Segment: A Case Report

TL;DR

A rare case of peripheral pulmonary torsion in a young man was diagnosed after initial misdiagnosis and ineffective treatment for pneumonia.

Contribution

This case report adds to the limited literature on peripheral pulmonary torsion and emphasizes its diagnostic challenges.

Findings

The patient had persistent symptoms despite antibiotic treatment, leading to surgical diagnosis of peripheral pulmonary torsion.

Intraoperative findings confirmed torsion of the peripheral lingular segment with a 360° rotation.

The patient recovered well post-surgery, highlighting the need for early recognition of this rare condition.

Abstract

Partial pulmonary torsion is extremely rare.

A 29-year-old man was initially treated with antibiotics for presumed bacterial pneumonia. Despite treatment, his inflammatory condition did not improve, and increasing pleural effusion was suggestive of empyema, leading to referral to our department. Following drainage, the patient’s condition did not improve. CT showed an increase in pleural effusion, with infiltrative shadows remaining within a clearly demarcated area, along with emphysematous changes in both lungs. He was diagnosed with lung abscess and empyema, and surgery was performed. Intraoperatively, the peripheral lingular segment appeared dark reddish, firm, and hyperlobulated. The affected area could be bluntly dissected, with its central portion narrowed but continuous with the central lingular segment, which rotated at least 360°. Peripheral pulmonary torsion was diagnosed, and a partial resection was performed. Postoperative recovery was uneventful.

Given the extreme rarity of peripheral pulmonary torsion, this case highlights the importance of considering torsion in persistent localized infiltrates unresponsive to treatment.

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