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REVIEW  INTEGRATED RX-ECO-TC IMAGING IN INTENSIVE CARE 

Il Giornale Italiano di Radiologia Medica 2018 Maggio-Giugno;5(3):440-52

DOI: 10.23736/S2283-8376.18.00081-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

ICU imaging after thoracic surgery

Beatrice FERAGALLI

Dipartimento di Scienze Mediche, Orali e Biotecnologiche, Università G. d’Annunzio, Chieti, Italia


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Radiological features observed in patients undergoing pulmonary surgery are multiple and variable; many of the acute alterations are closely related to the type of surgery and do not have significant clinical importance while others may underlie clinically relevant diseases that represent “early” complications. In the same way, after several days from the operative time, it is possible to identify persistent or new appearance changes, some of which represent “late” complications. Therefore, in all post-surgical patients it is advisable to know the so-called “expected” findings that represent the normal postoperative evolution based on the type of intervention and the “timing” with respect to the operative time, integrating the interpretation of the images with the clinical-laboratory findings. Only this knowledge will permit to recognize the so-called “not-expected” radiological features that can indicate possible complications. The most frequently performed pulmonary resection techniques include pneumonectomy (intrapleural, extrapleural or intrapericardial), lobectomy, segmental or atypical lung resections, pulmonary resections associated with bronchial or broncho-vascular anastomoses (sleeve lobectomy or sleeve pneumonectomy) and tracheo-bronchial resections. “Persistent air leak” - that is the persistence of pneumothorax, pneumomediastinum, or subcutaneous emphysema beyond the expected time - broncho-pleural fistula, and pleural empyema represent the most frequent complications in patients undergoing pulmonary resections. Persistent opacification of the pleural cavity may indicate the presence of bleeding. Anastomotic dehiscence is a generally “early” complication that can occur in all pulmonary interventions while anastomotic stenosis is a complication almost exclusively related to sleeve resection or tracheo-bronchial resection. Lobar torsion is a rare but fearful complication that may occur in patients undergoing lobectomy. In all post-surgical patients, it is also appropriate to evaluate the residual and contralateral lung parenchyma to identify complications such as atelectasis, infectious disease, pulmonary edema, or adult respiratory distress syndrome. Both in the early and in the late postoperative period, sequential examinations with chest radiography is strongly recommended in order to identify any alterations that could be missed if only the most recent radiograms are evaluated. When the radiographic findings are inconclusive or inconsistent with clinical features, computed tomography is helpful for establishing a diagnosis and identifying possible post-surgical complications.


KEY WORDS: Thoracic surgery - Pneumonectomy - Sleeve Lobectomy - Computed tomography

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