Lung torsion after pulmonary resection is a rare but potentially fatal complication. It most commonly occurs in the right middle lobe following right-sided resections. Left lower lobe torsion after left upper lobectomy is considerably less common than right middle lobe torsion. The patient underwent left upper lobectomy for a typical carcinoid tumor. During postoperative follow-up, serial chest radiographs demonstrated progressive consolidation of the left lower lobe; subsequent bronchoscopy revealed near-complete obstruction of the left lower lobe bronchus. Contrast-enhanced computed tomography demonstrated interruption of the left pulmonary arterial continuity, raising suspicion of left lower lobe torsion. Surgical exploration confirmed torsion with irreversible parenchymal injury, necessitating completion pneumonectomy. We present this rare and challenging clinical scenario in the context of the existing literature.
Intrathoracic extramedullary haematopoiesis (IEMH) is a rare manifestation of chronic haemolytic anaemia that typically presents as bilateral paraspinal masses in the posterior mediastinum and may be radiologically indistinguishable from neoplastic lesions. Optimal management, particularly the role of thoracic surgery, remains controversial. A 34-year-old woman with a long-standing history of haemolytic anaemia with spherocytosis presented with acute severe right-sided back pain. Chest computed tomography revealed splenomegaly and a large, well-circumscribed right paraspinal mass, radiologically indicative of either a neurogenic tumour or IEMH. Because of the high risk of intraoperative haemorrhage, immediate thoracic resection was deferred. Despite subsequent immunosuppressive therapy and localised radiotherapy, the paraspinal mass and symptomatic haemolysis remained unchanged. Consequently, laparoscopic splenectomy was conducted for definitive haematological management after preoperative immunisation against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b. Postoperatively, the patient experienced progressive clinical improvement with normalisation of haemoglobin levels and complete resolution of back pain. Serial imaging over an 8-year period demonstrated substantial involution of the intrathoracic mass following haematological stabilisation, without any direct thoracic surgical intervention. This case highlights that optimisation of the underlying haematological disorder can achieve both symptomatic relief and radiological regression of IEMH. Careful radiological assessment and a multidisciplinary approach, with priority given to the optimisation of the underlying haematological condition, are essential to avoid unnecessary invasive procedures.
