Differentiating Imaging Features of Post-lobectomy Right Middle Lobe Torsion

Abstract

Purpose: The purpose of this study was to identify differences in imaging features between patients with confirmed right middle lobe (RML) torsion compared to those suspected yet without torsion.

Materials and methods: This retrospective study entailing a search of radiology reports from April 1, 2014, to April 15, 2021, resulted in 52 patients with suspected yet without lobar torsion and 4 with confirmed torsion, supplemented by 2 additional cases before the search period for a total of 6 confirmed cases. Four thoracic radiologists (1 an adjudicator) evaluated chest radiographs and computed tomography (CT) examinations, and Fisher exact and Mann-Whitney tests were used to identify any significant differences in imaging features ( P <0.05).

Results: A reversed halo sign was more frequent for all readers ( P= 0.001) in confirmed RML torsion than patients without torsion (83.3% vs. 0% for 3 readers, one the adjudicator). The CT coronal bronchial angle between RML bronchus and bronchus intermedius was larger ( P= 0.035) in torsion (121.28 degrees) than nontorsion cases (98.26 degrees). Patients with torsion had a higher percentage of ground-glass opacity in the affected lobe ( P= 0.031). A convex fissure towards the adjacent lobe on CT ( P= 0.009) and increased lobe volume on CT ( P= 0.001) occurred more often in confirmed torsion.

Conclusion: A reversed halo sign, larger CT coronal bronchial angle, greater proportion of ground-glass opacity, fissural convexity, and larger lobe volume on CT may aid in early recognition of the rare yet highly significant diagnosis of lobar torsion.

Keywords: bronchial angle; lobar torsion; lobectomy; reversed halo sign; torsion.