Learning objectives
The aim of this work is to describe the major surgical procedures in thoracic surgery and to analyse the role of imaging modalities at our disposal,
the Chest X-ray (CXR) (both the supine one in anteroposterior projection - particularly in the immediate postoperative period - as the standard upright one in posteroanterior and lateral projections) and the Computed Tomography (CT) of the chest,
in identifying early and late postoperative complications,
distinguishing them from expectedfindings,
which are physiological anatomical modifications following surgery.
Background
Despite advances in surgical and anaesthetic techniques and in postsurgical supportive therapy,
the incidence of complications is still fair until nowadays (24-41%) [1] and mortality varies depending on the type of surgical procedure [2].
Therefore patients undergoing pulmonary resection are always considered at high-risk of developing complications during postoperative period.
Risk factors for complications and mortality are linked to patient’s clinical conditions (older age,
obesity,
comorbidities – especially cardiovascular conditions -,
reduced lung function,
underlying pulmonary disease) and to surgical technique.
The interpretation of radiological...
Findings and procedure details
Imaging,
particularly CXR,
the fist instance imaging modality in this kind of clinical practice,
is essential during the follow-up of patients undergoing thoracic surgery,
especially in the early phase.
CXR,
performed bedside supine in the very first postoperative days and,
as soon as possible,
upright in the two orthogonal incidences,
allows monitoring of the evolution of physiological findings,
as well as identifying “not expected” signs,
even without clinical suspicion: for this purpose,
the retrospective analysis of serial X-rays as an extreme utility.
However,
CXR has...
Conclusion
Imaging plays a vital role during follow-up of patients submitted to thoracic surgery,
particularly in the identification of postsurgical complications,
some of which are potentially life-threatening,
especially during theearly phase.
CXR remains the first instance modality; in case of findings inconclusive or discordant with the clinical setting,
chest CT can exclude or identify the presence of complications.
Therefore for the Radiologist it is essential to distinguish possible expected findings from real postsurgical complications and correlatingthem to clinical settings in which specific complications are more likely...
Personal information
Dr.
Giuseppe Cicchetti
Resident doctor in Radiology
Department of Radiology - Catholic University of Sacred Heart - Policlinico “A.
Gemelli” Foundation – Rome,
Italy
[email protected]
References
1.
Bommart S,
Berthet JP,
Durand G,
Pujol JL,
Mathieu C,
Marty-Ané C,
Kovacsik H.
Imaging of postoperative complications following surgery for lung cancer.
Diagn Interv Imaging.
2015; S2211-5684(15)00242-9.
2.
Kim EA,
Lee KS,
Shim YM,
Kim J,
Kim K,
Kim TS,
Yang PS.
Radiographic and CT findings in complications following pulmonary resection.
Radiographics.
2002; 22(1):67-86.
3.
Stéphan F,
Boucheseiche S,
Hollande J,
Flahault A,
Cheffi A,
Bazelly B,
Bonnet F.
Pulmonary complication following lung resection: a comprehensive analysis of incidence and possible risk factors....