Lung torsion

An asymptomatic 79-year-old woman with a recent history of pneumonia was referred for further investigation. Her breath sounds were decreased over the right upper chest. A chest x-ray showed decreased vascular shadows in the right upper lung field (figure 1, arrowheads), a loss of the right pulmonary artery shadow (figure 1, arrows) and attenuated translucency in the right lower lung field. CT showed backward rotation of the right pulmonary artery and vein (figure 2). Torsion of the right lung was subsequently diagnosed. The patient underwent video-assisted thoracic surgery to reposition the affected lung, and the chest x-ray normalised with restoration of the vascular shadows (figure 3).