Chest
Volume 102, Issue 6, December 1992, Pages 1697-1703
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Clinical Investigations
Can Portable Chest X-ray Examination Accurately Diagnose Lung Consolidation After Major Abdominal Surgery?: A Comparison With Computed Tomography Scan

https://doi.org/10.1378/chest.102.6.1697Get rights and content

Purpose

To prospectively quantify the degree of accuracy of portable chest x-ray film examination in the detection of postoperative lung consolidations.

Study

Nineteen patients had a chest x-ray film and computed tomography (CT) scan the day before and 48 h following elective abdominal aortic replacement.

Results

The diagnosis of lung consolidations by x-ray film examination showed sensitivity of between 0.33 and 1.00, depending on the lung zone considered (lower at the lung bases). Specificity always was greater than 0.79. Radiologic lung volume decreased 16 percent postoperatively (p<0.01) on average and noninflated parenchyma increased by a factor of 3 (p<0.0001). Postoperatively, PaO2 correlated with the amount of condensed lung by CT scan (p<0.002).

Conclusion

In postoperative conditions, x-ray film examination is a method which presents good specificity but poor sensitivity in the diagnosis of lung consolidations.

Section snippets

Subjects

Nineteen consecutive patients (Table 1) were enrolled in this study which had been approved by the Ethics Committee of our institution. All patients were scheduled for elective aortic replacement. Apart from one patient, the population studied was composed of male subjects who were all active or former smokers. Five of them had a FEV1 <60 percent of predicted values. None had preoperative resting hypercarbia. No significant thoracic abnormalities were present on the reference standard

Results

The results are summarized in Tables 2 and 3.

Discussion

The main finding of this study was that in an unselected surgical population undergoing major abdominal surgery, x-ray films were characterized by poor sensitivity but good specificity for the detection of lung consolidation, especially in basal zones. Interestingly, the total amount of densities assessed by CT scan were correlated to postoperative PaO2, but not to the change in lung volume.

The conventional x-ray film examination remains the traditional and always available method for assessing

Acknowledgements

The authors thank Mrs. Gillian Debrabander for her help in editing the manuscript.

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    Manuscript received December 16, 1991; revision accepted April 22.

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