Subject(s)
Brain Ischemia/diagnosis , Intraoperative Complications/diagnosis , Monitoring, Intraoperative/methods , Superior Vena Cava Syndrome/diagnosis , Early Diagnosis , Humans , Jugular Veins/physiopathology , Male , Mediastinal Neoplasms/surgery , Spectroscopy, Near-Infrared/methods , Venous Pressure/physiology , Young AdultABSTRACT
A 77-year-old man underwent esophagectomy for esophageal cancer. Chest radiograph just after the operation showed opacification of the right lung. Although chest radiograph still showed a marked opacification of almost whole right lung in the ICU in spite of multiple bronchoscopy examination and suctioning of pulmonary secretions, he showed no dyspnea. On the second postoperative day, his respiratory symptoms deteriorated unexpectedly. Computed tomography showed torsion of the right upper and middle lobes, and urgent surgery was scheduled. Following double-lumen endotracheal intubation, thoracotomy was performed under one lung ventilation. The lung was found rotated. The surgeons tried to reduce the torsion to preserve the viable lung, but failed. Bleeding from infarcted lung was observed (approximately 150 ml). Accordingly, stapled lobectomy was performed. After the second surgery, he fortunately recovered without any complications. Although lung torsion is a rare complication, not only thoracic surgeons, but also we, anesthesiologists, should be aware of this disease.
