A case of iatrogenic right middle lobe torsion after radiofrequency ablation with artificial pleural effusion for liver metastasis of colon cancer

Tanaka Hiroshi, Okada Akira, Aoki Tadashi

doi:10.2995/jacsurg.38.114

<p>A 68-year-old woman with liver and lung metastases from colon cancer underwent radiofrequency ablation with infusion of intrapleural ﬂuid for liver metastasis. After treatment, transient right chest pain, cough, and bloody sputum were present. Twenty-two days later, whole-body contrast-enhanced computed tomography for evaluation of metastases revealed torsion of the right middle lobe. Since there were no signs of infection or necrosis, video-assisted thoracic surgery was performed 3 days later. As the upper and lower lobes were adherent to the chest wall and diaphragm, respectively, and the interlobar fissure was completely separated, only the right middle lobe without adhesions was considered to have been collapsed by the artificial pleural fluid. Furthermore, the presence of a metastatic lung tumor in the right middle lobe was suspected to have caused the right middle lobe torsion due to buoyancy that inverted the right middle lobe. Although the twisted right middle lobe was adherent to the lower lobe and the visceral pleura was thickened due to inflammation, the right middle lobe was resected safely, and the postoperative course was uneventful. Since it is difficult to predict and prevent lung torsion caused by artificial pleural effusion, it may be possible to preserve the lung with detorsion if the lung torsion is detected by radiological examination early enough.</p>

A case of iatrogenic right middle lobe torsion after radiofrequency ablation with artificial pleural effusion for liver metastasis of colon cancer

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