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Spontaneous Pulmonary Torsion Secondary to Left Upper Lobe Malignancy.

Journal of Thoracic Oncology ® • Volume 10, Number 11, November 2015 CASE REPORT A 72-year-old man with known left upper lobe moderately differentiated mucinous adenocarcinoma presented with shortness of breath 3 weeks after diagnosis, during ongoing work-up. Work-up to date demonstrated no evidence of metastatic disease. He was presumed to have postobstructive pneumonia and antibiotics started. Prior imaging was suspicious for pericardial invasion, so dedicated gated cardiac magnetic resonance imaging was performed. This demonstrated findings suggestive of pulmonary torsion (Fig. 1). Chest computed tomography was performed immediately thereafter and confirmed 180° torsion of the left upper lobe (Fig. 2). The patient was emergently taken for thoracic exploration. Obstruction of the left mainstem bronchus due to rotation was demonstrated upon flexible bronchoscopy. Upon entering the left hemi-thorax via thoracotomy, a 180° counterclockwise axial rotation of the lung around the hilum was identified. Anatomy was notable for the upper lobe being distended and