PMC5508618_01
Chest contrast-enhanced CT showing a convoluted appearance (a) on the central side of S5 and consolidation on the peripheral side. There was a border with a linear structure (b) thought to be an accessory fissure between S4 and S5 (A). Bronchus, pulmonary artery, and vein of S5 became constricted, bent and rolled up to form a convoluted shadow (B, C).
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Chest contrast-enhanced computed tomography (CT) revealed a convoluted appearance (Fig. 1A, a) in the central side of the inferior segment of the lingula (S5) and consolidation in the peripheral side (Fig. 1). Bronchus, pulmonary artery, and the vein of S5 became constricted, bent, and rolled up and formed a convoluted shadow in the image (Fig. 1B and C). There was a border with linear structure thought to be the accessory fissure between the superior segment of the lingula (S4) and S5 (Fig. 1A, b).
Thoracoscopy showing the lingula segment (S4 + S5) bent on the head side and turned 180  counterclockwise. S5 showed a blackish appearance and seemed to be necrotized; however, S4 showed no changed in color even though it was twisted.
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During thoracoscopy, the lingula segment (S4 + S5) was observed to be bent on the head side and turned 180  counterclockwise (Fig. 2).