Middle lobe pulmonary congestion without pulmonary torsion after right upper lobectomy -A case report

A 78-year-old female underwent right upper lobe resection and ND2a-2 lymph node dissection for cancer (cT1aN2M0 Stage IIIA). On the first postoperative day, a chest radiograph showed decreased opacity in the right upper lung field, and CT showed consolidation of the middle lobe S5, which appeared to be atelectasis, and stenosis of the peripheral bronchi in the middle lobe, but there was no obvious evidence of middle lobe torsion, so the patient was treated conservatively. However, on the third postoperative day, the patient developed a fever in the 38°C range, and CT of the chest showed increased consolidation, so we decided to perform an extra surgery. Intraoperative findings showed that most of the right middle lobe was congested, but there was no evidence of tortuosity of the middle lobe and no problematic veins in the middle lobe. The remaining middle lobe was resected because of the possibility of pulmonary necrosis, and the middle lobe was judged to be nonpreservable. After reoperation, both clinical symptoms and blood tests improved promptly. Although pulmonary torsion is a known postoperative complication that can cause pulmonary congestion, it should be noted that pulmonary congestion can occur without torsion.