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Middle lobe pulmonary torsion after recurrent pleural effusions in a cirrhotic patient
  1. Gilberto Szarf1,
  2. Caroline Fontes R Dario1,
  3. Rodrigo Caruso Chate1,
  4. Elaine Yanata1,
  5. Eduardo Werebe2,
  6. Marcelo Buarque Gusmao Funari1
  1. 1Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
  2. 2Department of Thoracic Surgery, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
  1. Correspondence to Dr Gilberto Szarf, Department of Radiology, Hospital Israelita Albert Einstein, Av. Albert Einstein 627/701, Building D, 4th floor, Radiology Department, Sao Paulo, SP 05652-000, Brazil; gilbertos{at}einstein.br

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A 57-year-old man was admitted with acute chest pain and shortness of breath. He had cirrhosis secondary to hepatitis C infection and had undergone multiple thoracocentesis in the last months for recurrent pleural effusions. Chest X-ray showed increased density in the right lung base and chest CT showed a right pleural effusion, partial atelectasis of the right lower lobe, middle lobe bronchovascular structures twisted on themselves with a swirling appearance, obliteration of the proximal middle lobe artery, narrowing of the accompanying bronchus and ground-glass opacities in this same lobe (figure 1). Symptoms persisted over the next week and …

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