Lobar Torsion Following Open Repair of Type B Aortic Dissection and Thoracoabdominal Aortic Aneurysm in a Patient with Marfan Syndrome

Yousef AlMutawa; Diana E Olaya; Gao S Huang; Marta Kaminska; Josephine Pressacco; Jonathan Spicer; Oren Steinmetz

doi:10.1016/j.ejvsvf.2023.05.016

Lobar Torsion Following Open Repair of Type B Aortic Dissection and Thoracoabdominal Aortic Aneurysm in a Patient with Marfan Syndrome

EJVES Vasc Forum. 2023 Jun 2:60:8-11. doi: 10.1016/j.ejvsvf.2023.05.016. eCollection 2023.

Authors

Yousef AlMutawa¹, Diana E Olaya², Gao S Huang³, Marta Kaminska², Josephine Pressacco⁴, Jonathan Spicer⁵, Oren Steinmetz¹

Affiliations

¹ Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada.
² Respiratory Division, McGill University Health Centre, Montreal, Quebec, Canada.
³ Département de Médecine, Université de Montréal, Montreal, Quebec, Canada.
⁴ Division of Radiology, McGill University, Montreal, Quebec, Canada.
⁵ Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.

Abstract

Introduction: Lobar torsion is a rare, challenging diagnosis that requires a high index of suspicion and prompt investigation and management. Detection and urgent fixation or lung resection are critical to avoid catastrophic sequelae of lung necrosis, bronchopleural fistulae, and death.

Report: A case of lobar torsion following open repair of a type B aortic dissection and thoraco-abdominal aortic aneurysm in a patient with Marfan syndrome is presented. After a non-specific constellation of symptoms, the diagnosis was confirmed with computed tomography and bronchoscopic findings and the patient underwent detorsion and plication of a torted, yet viable, left upper lobe on post-operative day 6. The patient is currently being followed with serial imaging to follow a necrotic consolidation of the left upper lobe.

Discussion: This was a case of lobar torsion in a patient with Marfan syndrome and the degree of connective tissue disease may have predisposed the patient to this rare surgical complication. The case presents a challenging dilemma due to the risks associated with exposing a synthetic aortic graft to a potentially infected space if lobar resection or a pneumonectomy was performed.

Keywords: Aortic dissection; Lobar ischaemia; Lobar torsion; Marfan syndrome; Thoracoabdominal aneurysm.

Publication types

Case Reports