title: Postlobectomy chest radiographic changes: a quantitative analysis.
abstract: OBJECTIVE
  To provide a quantitative analysis of postlobectomy chest radiographic changes and to evaluate whether the scarring from prior sternotomy affects the size of the hemithorax and the duration of air leak in patients with subsequent lobectomy.
  
  
  METHODS
  In this retrospective case-controlled series, 10 consecutive patients who had a lobectomy after a prior sternotomy and 30 controls, 3 for each case, matched for lobectomy site were identified. Pre- and postoperative chest radiographs were quantitatively analysed for diaphragmic elevation, size of each hemithorax, mediastinal shift, and the presence of pneumothorax. Charts were reviewed for air-leak duration, surgical complications, and duration of hospitalization.
  
  
  RESULTS
  There was no difference between patients with lobectomy and with and without prior sternotomy for the following variables expressed as mean (SD): hemidiaphragm elevation (1.5 ± 2.5 vs 0.5 ± 2.0 cm; P = .2), change of hemithorax size (mean transverse, 0.99 ± 0.05 vs 0.97 ± 0.07; P = .5; craniocaudal, 0.93 ± 0.08 vs 0.91 ± 0.08; P = .4) and mediastinal shift (upper, 1.2 ± 0.4 vs 1.3 ± 0.6; P = .5; lower, 1.2 ± 0.4 vs 1.2 ± 0.3; P = .8), the latter 2 were expressed as the ratio of post- to preoperative measurements. These postlobectomy radiographic findings varied, depending on the resected lobe, and became progressively more pronounced during the first 12 months after surgery. There was no difference in pneumothorax duration (mean [SD]) (9.5 ± 21 days vs 6.4 ± 7.5 days; P = .5), air leak duration (mean [SD]) (0.7 ± 0.8 days vs 1.3 ± 3.9 days; P = .6), complication rate (20% vs 30%; P = .5), or hospital stay (mean [SD]) (6.0 ± 1.7 days vs 6.9 ± 4.7 days; P = .6).
  
  
  CONCLUSIONS
  There are specific patterns of volume loss, mediastinal shift, and hemidiaphragm displacement that can be quantified on postlobectomy chest radiographs. Prior sternotomy did not affect postlobectomy radiographic changes or patient outcome.
authors.affiliation: Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Choo-Won
authors.initials: CW
authors.lastname: Kim
authors.forename: Alla
authors.initials: A
authors.lastname: Godelman
authors.forename: Vineet R
authors.initials: VR
authors.lastname: Jain
authors.forename: Avraham
authors.initials: A
authors.lastname: Merav
authors.forename: Linda B
authors.initials: LB
authors.lastname: Haramati
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002921:Cicatrix / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000379:methods*; D011030:Pneumothorax / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D056346:Sternotomy; D013906:Thoracoscopy; D016896:Treatment Outcome