EURORAD ESR

Case 11690

Traumatic pulmonary torsion leading to complete bronchovascular avulsion

Author(s)
Amir Awwad, Yutaro Higashi, Greg Ramjas

Nottingham Univ. Hospitals,
Radiology Department;
Derby Road NG7 Nottingham;
Email:amirawwad@hotmail.com
 
Patient
female, 45 year(s)
 
 
  • Figure 1
    Pulmonary hilar torsion (twirl sign)

    Coronal cross sectional imaging in a sequential movie from medial to lateral showing the right-sided pulmonary torsion effect on the lobar parenchyma and bronchial tree.

     
    Area of Interest: Arteries / Aorta; Cardiovascular system; Emergency; Imaging Technique: CT; Procedure: Diagnostic procedure; Surgery; Special Focus: Acute; Trauma;
     
     
  • Figure 2
    Pulmonary torsion (beak sign)

    Axial cross sectional imaging (arterial phase) showing an abrupt cut-off "beak sign" (white arrow) of the right main pulmonary artery.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT; Procedure: Diagnostic procedure; Surgery; Special Focus: Acute; Trauma;
     
     
  • Figure 3
    Pulmonary torsion (lung window)

    Axial cross sectional image in lung attenuation window showing indrawing of vessels and contusional torted lung markings. A chest drain is inserted in the right hemithorax.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT; Procedure: Diagnostic procedure; Surgery; Special Focus: Acute; Trauma;
     
     
  • Figure 4
    Pulmonary torsion (perfusion cut-off)

    Axial cross sectional image (arterial phase) showing a non-perfused middle lobe due to an acute cut-off blood supply due to acute hilar torsion.

     
    Area of Interest: Arteries / Aorta; Cardiovascular system; Lung; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute; Trauma;
     
     
  • Figure 5
    Pulmonary torsion (multi-planar reconstruction)

    Coronal multi-planar reconstruction (MPR) of both lungs with a posterior view showing an abrupt traumatic avulsion (cut-off) to the right main bronchus (black arrow).

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT; Procedure: Diagnostic procedure; Surgery; Special Focus: Acute; Trauma;
     
     
  • Figure 6
    Pulmonary torsion (lung window)

    CT sagittal plane (lung window) showing a twirling sign of the hilar structures with an abnormal rotation of the right lung lobes in an anti-clock torsion, M=middle lobe, L= Lower lobe, U= Upper lobe.

     
    Area of Interest: Arteries / Aorta; Cardiovascular system; Lung; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute; Trauma;
     
     
Coronal cross sectional imaging in a sequential movie from medial to lateral showing the right-sided pulmonary torsion effect on the lobar parenchyma and bronchial tree.
 
Axial cross sectional imaging (arterial phase) showing an abrupt cut-off "beak sign" (white arrow) of the right main pulmonary artery.
 
Axial cross sectional image in lung attenuation window showing indrawing of vessels and contusional torted lung markings. A chest drain is inserted in the right hemithorax.
 
Axial cross sectional image (arterial phase) showing a non-perfused middle lobe due to an acute cut-off blood supply due to acute hilar torsion.
 
Coronal multi-planar reconstruction (MPR) of both lungs with a posterior view showing an abrupt traumatic avulsion (cut-off) to the right main bronchus (black arrow).
 
CT sagittal plane (lung window) showing a twirling sign of the hilar structures with an abnormal rotation of the right lung lobes in an anti-clock torsion, M=middle lobe, L= Lower lobe, U= Upper lobe.
 
 
 
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