Postoperative Chest Radiographs Research Articles

Optimal Technique for Primary Spontaneous Pneumothorax in Children

Surgery| March 01 2009 Optimal Technique for Primary Spontaneous Pneumothorax in Children AAP Grand Rounds (2009) 21 (3): 29. https://doi.org/10.1542/gr.21-3-29 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Optimal Technique for Primary Spontaneous Pneumothorax in Children. AAP Grand Rounds March 2009; 21 (3): 29. https://doi.org/10.1542/gr.21-3-29 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: primary spontaneous pneumothorax, thoracic surgery, video-assisted, pleurodesis, blister Source: Bialas R, Weiner T, Phillips D. Video-assisted thoracic surgery for primary spontaneous pneumothorax in children: is there an optimal technique? J Pediatr Surg. 2008;43(12):2151–2155; doi:10.1016/j.jpedsurg.2008.08.041 To assess outcomes and compare different techniques using video-assisted thoracic surgery (VATS) for the treatment of primary spontaneous pneumothorax (PSP) in children, investigators from the University of North Carolina reviewed the records of 32 children treated from 1999 to 2007 by a single group of surgeons. The indications for VATS were either presence of persistent air leak after placement of a chest tube, recurrent ipsilateral pneumothorax, or occurrence of a contralateral pneumothorax. Children with underlying lung disease (such as cystic fibrosis), trauma, or cancer were excluded. The surgical technique via thoracoscopy was determined by the operating surgeon. Bleb resection was performed using an endoscopic stapling device. Pleurodesis was done either mechanically via cautery scratch pad abrasion and/or pleural stripping, or chemically by coating the pleura with a fine dust of sterile talc powder. A chest tube was placed at the conclusion of the procedure and only removed when air leak ceased and postoperative chest radiographs showed no residual pneumothorax. The study population consisted of 32 patients who had 41 procedures. Mean age of patients in the study was 16.5 years; 25 were male. Overall the mean postoperative air leak duration was 2.7 days with a prolonged air leak of >7 days in five patients. Mean hospital length of stay after surgery was 5.0 days. The mean postoperative chest tube duration was 5.1 days. Blebs, mostly upper lobe, were identified during 95% of VATS procedures. Among the different surgical techniques, patients treated with thoracoscopic blebectomy and mechanical pleurodesis (n=31) had the shortest length of stay (mean of 4.3 days). Seven of the 32 patients (22%) subsequently developed contralateral PSP requiring VATS. Two patients developed recurrent ipsilateral PSP requiring VATS within one year of the original procedure; both were found to have blebs not originally seen and in the lower lobes. The failure rate of VATS cases in preventing future pneumothorax was 5% (2/39). Blebectomy plus mechanical pleurodesis led to five minor recurrences which did not require repeat VATS and were successfully treated non-operatively. No major or minor recurrences were seen in the group treated with blebectomy and chemical pleurodesis (n=6). The authors conclude that both chemical and mechanical pleurodesis with blebectomy are associated with acceptable patient outcomes. Dr. Cavett has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. PSP usually occurs in healthy adolescents without other lung disease.1 Recent studies have shown that rapid adolescent linear growth of the thorax compared with horizontal growth is likely to cause increase in negative pressure at the apex of the lung, which may lead to subpleural bleb formation and subsequent PSP upon rupture.1 Nonoperative treatment with observation as an inpatient includes needle aspiration and/or tube thoracostomy. This conservative therapy has been associated with a recurrence... You do not currently have access to this content.

Port-A-Cath Implantation Using Percutaneous Puncture Without Guidance

The implantation of a Port-A-Cath (PAC) is a common surgical procedure usually done under guidance with techniques such as fluoroscopy, ultrasound, or intravenous electrocardiography. PAC implantation without guidance avoids radiation exposure and decreases time, expense, and complexity. The purpose of this study was to analyze the success rate, and operation-related and postoperative complications of PAC implantation without intraoperative guidance. Between July 2004 and June 2007, 1,070 PACs were implanted in 1,025 patients receiving chemotherapy. All PACs were placed via the subclavian vein by percutaneous puncture. The catheter length was precalculated for each patient. Postoperative chest radiography was immediately performed to check the catheter position. All data on outcome of the implantations were reviewed retrospectively. The catheter tip was correctly placed at the cavoatrial junction without complications in 1,055/1,070 (98.6%) of the implants. Surgery-related complications occurred in 15 (1.4%) implantations: 9 malposition, 3 pneumothorax, 2 hematoma, and 1 catheter kinking. Two patients underwent PAC removal due to hematoma with subsequent wound infection in one and catheter occlusion by kinking in the other. There were 86 (8.0%) postoperative complications that resulted in PAC removal: catheter occlusion in 24 (2.2%), pocket infection in 22 (2.1%), catheter rupture in 11 (1.0%), venous thrombosis in 9 (0.8%), port exposure in 9 (0.8%), catheter fracture in 6 (0.6%), infraclavicular pain in 3 (0.3%), catheter migration in 1 (0.1%), and extraportal injection in 1 (0.1%). PACs can be safely and accurately placed using percutaneous puncture of the subclavian vein without intraoperative guidance.

Relationship between left ventricular lead position using a simple radiographic classification scheme and long-term outcome with resynchronization therapy

Benefit from cardiac resynchronization therapy (CRT) is likely influenced by the location of the left ventricular (LV) lead. To evaluate the association of LV lead position with outcome after CRT. Two-hundred and fifty patients with LV dysfunction, New York Heart Association (NYHA) class III (68%) or IV (32%) symptoms, and QRS durations > or =120 ms were followed for a median of 30 months post-CRT. LV lead position was categorized as anterior (n = 20, 8%), lateral (n = 128, 51%), or posterior (n = 102; 41%) using postero-anterior and lateral postoperative chest radiographs. Median age was 69 years and most (68%) had ischemic LV dysfunction. Clinical response, defined by a > or =1 NYHA class reduction, was lower in patients with an anterior (30%) versus lateral (76%) or posterior (73%) lead position (p = 0.001). An anterior versus nonanterior position was independently associated with a two to three-fold higher risk for nonresponse to CRT, cardiovascular death, death from worsening heart failure or cardiac transplantation, and death from any cause. Repositioning of the LV lead from an anterior to a nonanterior position in seven patients who had not clinically responded to CRT after > or =6 months resulted in clinical improvement in all cases. An anterior versus nonanterior LV lead position is independently associated with an increased likelihood of nonresponse to CRT and a higher risk of serious outcomes. Repositioning of an anteriorly placed LV lead to a nonanterior position should be considered in CRT nonresponders.

Abscess of Residual Lobe after Pulmonary Resection for Lung Cancer

Abscess of the residual lobe after lobectomy is a rare but potentially lethal complication. Between January 1975 and December 2006, 1,460 patients underwent elective pulmonary lobectomy for non-small-cell lung cancer at our institution. Abscess of the residual lung parenchyma occurred in 5 (0.3%) cases (4 bilobectomies and 1 lobectomy). Postoperative chest radiography showed incomplete expansion and consolidation of residual lung parenchyma. Flexible bronchoscopy revealed persistent bronchial occlusion from purulent secretions and/or bronchial collapse. Computed tomography in 3 patients demonstrated lung abscess foci. Surgical treatment included completion right pneumonectomy in 3 patients and a middle lobectomy in one. Complications after repeat thoracotomy comprised contralateral pneumonia and sepsis in 1 patient. Residual lobar abscess after lobectomy should be suspected in patients presenting with fever, leukocytosis, bronchial obstruction and lung consolidation despite antibiotic therapy, physiotherapy and bronchoscopy. Computed tomography is mandatory for early diagnosis. Surgical resection of the affected lobe is recommended.

Catheters, wires, tubes and drains on postoperative radiographs of pediatric cardiac patients: the whys and wherefores

Surgical treatment of congenital heart disease has advanced dramatically since the first intracardiac repairs in the mid-20th century. Previously inoperable lesions have become the focus of routine surgery and patients are managed successfully in intensive care units around the world. As a result, increasing numbers of postoperative images are processed by departments of radiology in children's hospitals. It is important that the radiologist accurately documents and describes the catheters, wires, tubes and drains that are present on the chest radiograph. This article reviews the reasons for the placement and positioning of perioperative equipment in children who have surgical repair of atrial septal defect, ventricular septal defect or transposition of the great arteries. Also included are a brief synopsis of each cardiac anomaly, the surgical procedure for its correction, and an in-depth discussion of the postoperative chest radiograph including illustrations of catheters, wires, tubes and drains.

Delayed Tension Pneumothorax Detected 4 Days after Central Venous Catheterization - A case report -

Pneumothorax is one of the most frequent complications of percutaneous central venous catheterization.Most significant pneumothoraces are easily detected on postcatheterization chest radiograph.However, we report a rare case of delayed tension pneumothorax detected 4 days after unsuccessful central venous catheterization via the infraclavicular subclavian vein, although initial postcatheterization and postoperative supine chest radiographs showed no active lesion.

Cardiac Transplantation in a Patient With Effective Single Left Lung Physiology

Cardiac Transplantation in a Patient With Effective Single Left Lung Physiology

Hazardous Course of an End-tidal Carbon Dioxide Catheter in a Premature Infant

Hazardous Course of an End-tidal Carbon Dioxide Catheter in a Premature Infant

Predictors of independent lung ventilation: An analysis of 170 single-lung transplantations

Single-lung transplantation for chronic obstructive pulmonary disease can cause unique postoperative problems that might require independent lung ventilation. We evaluated preoperative and immediate postoperative factors to predict the need for independent lung ventilation. We retrospectively studied 170 patients who received a single-lung transplant over a 15-year period, 20 (12%) of whom required independent lung ventilation. Patients requiring independent lung ventilation were similar in age, sex, ischemic time, and donor characteristics to those who required conventional ventilation. Patients receiving independent lung ventilation had a greater degree of preoperative airflow limitation, more hyperinflation, lower postoperative PaO2/fraction of inspired oxygen ratios, more radiologic mediastinal shift, and more transplant lung infiltrate on the postoperative chest radiograph. Multivariate logistic regression analysis showed that independent lung ventilation was associated with increasing levels of recipient hyperinflation (percentage total lung capacity compared with predicted value; odds ratio, 1.04; 95% confidence interval, 1.01-1.07; P = .032) and reduced early postoperative PaO2/fraction of inspired oxygen ratio (odds ratio, 0.97; 95% confidence interval, 0.95-0.99; P = .005). Length of ventilation and intensive care unit stay and mortality were higher in the independent lung ventilation group. Among patients who survived to hospital discharge, there were no differences in long-term mortality between the 2 groups. The need for independent lung ventilation in patients undergoing single-lung transplantation for obstructive lung disease is predicted by the combination of increased hyperinflation measured on recipients' preoperative lung function tests and a low PaO2/fraction of inspired oxygen ratio, indicating graft dysfunction in the immediate postoperative period.

Radiological assessment of children with pectus excavatum

To assess what degree of chest wall deformation changes statistically reliably after surgery, using pre- and postoperative radiological examination data. Radiological chest examinations were performed for 88 children before and after remedial operations. Pre- and postoperative chest radiograph and CT were performed to measure transversal chest width; sagittal left chest side depth, sagittal right chest side depth, sternovertebral distance and vertebral body length. Derivative indices were also estimated: Vertebral index (VI), Frontosagittal index (FI), Haller index (HI) and asymmetry index. Computerized assessment of data was used. For statistical analysis, the software "Statistica 6.0" was used. Postoperatively VI increased approximately by 2.37+/-2.72, FI decreased by 4.60+/-4.34 and HI value increased approximately up by 0.45+/-0.49. Statistically significant deformation index difference before and after surgery was not detected when VI was below 26.2 (p=0.08), FI was above 32.9 (p=0.079) and HI was less than 3.12 (p=0.098). Preoperative CT and X-ray assessment of chest wall deformation degree is important for pediatric patients. The following deformation indices are indications for surgical treatment: VI>26, FSI< 33 and HI>3.1.

A Persistent Left Superior Vena Cava: Erroneous Measurement of Cardiac Output

To the Editor: Placement of a pulmonary artery catheter (PAC) through a persistent left superior vena cava (PLSVC) may lead to erroneous cardiac output (CO) measurements. We report a 42-yr-old male who was scheduled for elective aortic valve reconstruction. After induction of anesthesia, a PAC was placed without difficulty and obviously in a correct distal position as confirmed by pressure recording (at 60 cm). However, pulmonary artery thermodilution measurement revealed a double-hump suggesting a shunt phenomenon (Fig. 1A).Figure 1.: (A) Thermodilution curves with a double-hump as obtained with the injection site of the pulmonary artery catheter in the coronary sinus. (B) Thermodilution curves without a double-hump as obtained after repositioning of the pulmonary artery catheter with a correct injection site in the right atrium.The PAC was retracted prior to cardiopulmonary bypass and re-advanced (at 65 cm) after successful weaning. The thermodilution curve then did not show a double-hump shape and CO was more than doubled (8.6 L min−1) (Fig. 1B). A postoperative chest radiograph (Fig. 2A) and computed tomography scan (Fig. 2B) revealed the PAC in a PLSVC.Figure 2.: (A) Chest radiograph showing a persistent left superior vena cava (PLSVC). Arrow head = tip of the pulmonary artery catheter, arrow = central venous catheter. (B) Chest computed tomography scan showing the position of the pulmonary artery catheter through the coronary sinus (indicated by the arrow). Arrow head = persistent left superior vena cava (PLSVC).In general, a PLSVC, being the most common thoracic venous anomaly (0.5%), is of no pathological consequence (1). In up to 92% of cases, the PLSVC drains into the right atrium through the coronary sinus (2) and patients with a PLSVC have an increased risk for atrial fibrillation due to bilateral pacemaker areas in the myocardium (3). Measurement of CO by the thermodilution technique is based on the Stewart–Hamilton principle: CO = m0/AUC Δt dt (m0 = mass of the indicator injected, AUC = area under the temperature curve). Whenever the AUC is increased (here by “re-circulation”) while keeping the amount of indicator injected unchanged, CO will be under-estimated. In our case, cold saline was injected into the coronary sinus yielding a pulmonary artery thermodilution curve with a double-hump which is similar to one observable in left-to-right shunt during which the pulmonary artery thermodilution curve is typically prolonged. Since a part of the indicator that has already passed the tip of the PAC re-circulates, a second, but less pronounced, decrease in temperature appears (4). In our patient, an intracardiac shunt could be excluded by echocardiography. Therefore, “re-circulation” from the coronary sinus into the right atrium was the cause of the described double-hump phenomenon. Consequently, the first AUC was artificially elevated, explaining the underestimation of CO. Re-positioning of the PAC to an increased insertion depth of about 65 cm resulted in a correct right atrial injection site, and a higher CO was measured without the “double-hump” phenomenon. In summary, a PAC advanced through a PLSVC may cause erroneous measurements of CO and particular attention has to be paid to the shape of the thermodilution curve in this setting. Wolfram Schummer, MD Claudia Schummer, MD Samir G.Sakka, MD, PhD Department of Anesthesiology and Intensive Care Medicine Friedrich-Schiller-University of Jena D-07740 Jena, Germany [email protected]

SIMPLE AND EFFECTIVE SUSPENSION TECHNIQUE FOR LAPAROSCOPIC CHOLECYSTECTOMY

Many surgeons elect to dispense with the lateral retraction port during laparoscopic cholecystectomy using the American four-port technique; however, this may not be easy and safe. To retain the superior ergonomical and observation advantages, suspension techniques that leave virtually no scars have been developed to substitute for the lateral retraction port. All published techniques for suspending the gall bladder fundus were reviewed and an attempt was made to evolve a technique that is expedient, safe and cost-effective. In our setting, the optimal technique is to pass a folded thread down a 14-G intravenous cannula that has punctured the abdominal wall to form a snare loop to entrap and hold the gall bladder fundus. The anchorage is maintained by a two-haemostat technique heretofore undescribed. In some of the cases where better exposure of the undersurface of the liver is needed, the cannula can be directed to puncture the thoracic cage at or below the seventh intercostal space to provide cephalad retraction and to rotate the liver superiorly. Postoperative chest radiographs did not show any pneumothorax. The simple suspension technique emulates the four-port technique's advantages in terms of favourable ergonomics and exposure (and hence safety). It is suitable for selected patients and due caution should be exercised.

Different outcomes between two sides after bilateral sympathetic ganglion interruption for hyperhidrosis

Background Although the determination of the correct ganglion under direct vision through thoracoscopy by an experienced surgeon is almost unerring, there is still a 4.3% rate of clipping at the unintended level. Methods Through the review of the most recent patients (N = 117) with various sympathetic disorders undergoing thoracoscopic sympathetic interruption over different ganglions by clipping, we found that 5 cases were clipped at the unplanned level. The immediate manifestations were the different outcomes between both sides of the face, trunk, and extremities. The postoperative chest radiographs demonstrated the error. Results All patients received a second operation in which the unintended clip was removed, and a new one was applied to the appropriate ganglion. The results were satisfactory. Conclusions Although the authors in this study have the experience of more than 1000 cases of hyperhidrosis, such an error is still inevitable. Luckily, by using the clipping method, the error is detectable and amendable.

End-to-side anastomosis for coarctation of the aorta and type a aortic arch interruption with hypoplastic aortic arch

We investigated the advantages of reconstructing the aortic arch in neonates and infants by end-to-side anastomosis (ESA) in aortic coarctation and type A aortic arch interruption. The patients were 28 neonates and infants who underwent median full sternotomy for correction of aortic coarctation (CoA) and type A interrupted aortic arch (IAA), at our institute, from October 1997 to September 2002. The cases were divided into two groups: ESA was performed in 16 cases (group A) and extended end to end anastomosis in 12 cases (group B). All repairs were made using simple clamping of the descending aorta under cardiac arrest. We compared groups A and B with regard to duration of simple clamping, postoperative blood pressure in the upper and lower extremities, echocardiographic pressure gradient, and the presence or absence of tracheal stenosis as diagnosed by postoperative clinical symptoms and chest radiography. No significant difference between the groups was found in age, gender, body weight, or the ratio of CoA to IAA. In addition, there was no difference between the two groups in the duration of simple clamping or the difference in blood pressure between the lower and upper extremities. However, the echocardiographic pressure gradient at the site of anastomosis in group A was significantly lower than that in group B. There were no cases with symptoms of bronchial stenosis in either group. ESA is a relatively simple method for treating CoA or IAA with hypoplastic aortic arch, and was found to be effective for the elimination of residual stenosis.

Unsuspected retained 60-cm intravenous guidewire

We report a case of a retained 60-cm intravenous guidewire that had inadvertently slipped into a patient during preoperative central line placement. This unsuspected guidewire was unrecognized on postoperative chest and abdominal radiographs, but was subsequently diagnosed much later at computed tomography. After 150 days within the patient, the guidewire was retrieved percutaneously without complication.

Diagnostic Dilemma: A Pacemaker Lead Inside the Left Atrium or an Echocardiographic Beam Width Artifact?

A 71-yr-old man with a permanent dual chamber pacemaker (pm), chronic atrial fibrillation with a slow ventricular response and symptomatic mitral regurgitation presented for mitral valve surgery. His intraoperative monitoring included, among others, a pulmonary artery catheter (PAC) and transesophageal echocardiography. The surgical approach was from the right atrium via an atrial septotomy, and the mitral valve was replaced. After separation from cardiopulmonary bypass, a strong reflector accompanied by distal acoustic shadowing was seen inside the left atrium (LA), in the mid-esophageal bicaval view at different degrees of rotation (see video clip at www.anesthesia-analgesia.org.). Migration of the PAC into the LA via the atrial septotomy was excluded, based on the fact that central venous and pulmonary artery pressure waveforms were transduced from the proximal and distal PAC ports, respectively. We considered that one of the permanent pm leads was apparently trapped inside the LA. However, the surgeon was adamant that this had not occurred, and the chest was closed. Further transesophageal echocardiography examination, using similar acoustic windows, failed to reproduce the artifact (Fig. 1). A postoperative portable chest radiograph verified that both permanent pm leads were anchored properly at the right atrium and right ventricular apex.Figure 1.: Modified, mid-esophageal bicaval view after chest closure. A, The left atrium (LA) is at the top of the image. Inside the right atrium (RA), a prominent Eustachian valve is seen to the left, close to the junction with the inferior vena cava (IVC), below the interatrial septum (IAS). One of the pacemaker leads (PM1) is visible. B, With further rotation to 92°, the second pacemaker lead (PM2) is visualized inside the RA.Apart from the main beam, ultrasound transducers emit secondary beams, or side lobes, propagating radially from the center of the main beam (Fig. 2). A returning echo produced by a target located in the side lobes will be displayed as if it originated inside the main beam. The ultrasound energy in the side lobes is considerably weaker than in the main beam; therefore, reflections become apparent only when they do not conflict with real, more intense echoes (1). Examples are an enlarged cardiac chamber, as in the case of a dilated aorta, when the atrial-aortic interface creates a reverberation artifact mimicking a dissection flap, (2) and/or a relatively strong reflector, such as a catheter or a wire (3). To reduce such artifacts, the gain settings should be minimized so that strong reflections from weaker lobes are decreased. If they persist, the echocardiographer may be able to differentiate an artifact from a real structure by imaging the same structure from another acoustic window. An artifact is not likely to be reproduced in multiple echocardiographic planes.Figure 2.: Main and side lobes of the ultrasound beam produced by a phased array transducer. The shadowed cylinder represents the main beam, and the surrounding truncated cone and arrows the side lobes.Shadowing is the absence of echoes behind a highly reflective target, such as mechanical devices (catheters, prostheses) or heavily calcified native structures. When shadowing occurs, an alternate acoustic window is required to view the objects or areas of interest (3). Closure of the atrial septotomy might have altered the relative position between the interatrial septum and the pm lead. As a result, part of the latter (a strong reflector), was reflected by the side lobe, off the center of the ultrasound beam. Approximation of the sternum and the influence of the ventilated lungs may have affected the size of the LA, possibly realigning the pm lead with the main beam of the ultrasound, thus “returning” the image in its true anatomic location, inside the right atrium.

Usefulness of the carina as a radiographic landmark for central venous catheter placement in paediatric patients

Several reports have proposed radiographic landmarks for the proper positioning of central venous catheters (CVC). The carina is one of the proposed landmarks in adults. Here, we evaluate the possibility of using the carina as a radiographic landmark for the identification of proper positioning of the CVC tip in paediatric patients. We studied 57 right internal jugular vein catheterizations in infants and children undergoing surgery for the treatment of congenital heart disease. After placing the CVC tip at the junction of the superior vena cava and the right atrium (SVC-RA junction) via intraoperative transoesophageal echocardiography, and by taking postoperative anterior-posterior chest radiographs, we measured the longitudinal distance from the carina to the SVC-RA junction, using the Picture Archiving and Communicating System. The average distance between the carina and the SVC-RA junction was 1.5 cm (95% CI 1.3-1.8 cm). No catheter tip was above the carina. Although there was no particular relationship between this distance and the patient's age, height, or weight, the distance between the carina and the SVC-RA junction tended to be more variable in younger and smaller children. The carina can be used as a radiographic landmark for the proper CVC tip placement in paediatric patients. If the tip of the CVC is not distal to the carina the chances are minute that it is in the right atrium.

Extensive atrial wall resection in a patient with symptomatic idiopathic right atrial enlargement

Extensive atrial wall resection in a patient with symptomatic idiopathic right atrial enlargement

Sci‐AM1 Sat ‐ 03: Comparison of chest radiographs, fluoroscopy and seed‐migration detector for the detection of embolized seeds to the lung

To evaluate the efficacy of a seed‐migration detector and to compare it to fluoroscopy and to the postoperative chest radiographs generally recommended. A gamma scintillation survey meter was converted to a seed‐migration detector. It was used to perform a chest evaluation on 155 patients (8717 seeds) at their first postoperative visit. When the detector showed activity around a patient's chest, it was confirmed by taking an antero‐posterior chest radiograph and by looking at the region with fluoroscopy. 3 patients (21.3%) present at least one embolized seed. That is a 0.47% seed migration rate (41/8717). 37 (90%) of the seeds were visible under fluoroscopy and 28 (68%) appeared on x‐rays. Rapid movement of the seeds, due to breathing or to a location close to the heart, makes nine seeds to be visible with fluoroscopy but not on the radiograph. Moreover, four seeds were not visible with fluoroscopy neither with radiograph. In comparison to the seed‐migration detector, detection based on fluoroscopy would have led to four false‐negative detections (out of 33 or 12.1%) while the radiograph would have resulted in thirteen or 39.4%. Moreover, x‐ray would have required extra radiation dose to lung to 100% of the patients rather than the 21.3% who needed it in this study. The recommendation to perform chest radiographs should be revised because of superior efficacy of the seed‐migration detector. X‐rays should only remain for documentation purposes. Finally, the detector is convenient, cost‐effective and non‐invasive: it does not require any additional radiation to the patient.

Postoperative chest radiographic changes after on- and off-pump coronary surgery

A variety of chest radiograph abnormalities are recognized after coronary artery bypass grafting (CABG). This study analyzes the appearance of preoperative and postoperative chest radiographs in two groups of patients undergoing myocardial revascularization with or without the use of cardiopulmonary bypass (CPB). Chest radiographs (preoperative and at 1 day, 6 days and 6 to 8 weeks post operatively) were analyzed according to a detailed protocol in cases of conventional CABG on CPB (n=60) or off-pump coronary artery bypass (OPCAB) (n=60) surgery. On each film 17 different major potential postoperative abnormalities were analyzed. Clinical findings were similar in the two groups. Patients undergoing OPCAB surgery had decreased blood loss, decreased red cell and platelet transfusion, significantly lower intubation time and required less postoperative inotropic support compared with patients undergoing CPB. The CPB group had a significantly higher incidence of left band atelectasis than the OPCAB group (37.6% vs 17.5%, p=0.01) at 6 days postoperatively. There was no other statistically significant difference in any of the 16 remaining major chest radiograph findings between the two groups. Although OPCAB surgery is associated with improved clinical outcome compared with conventional CABG surgery, the analysis of postoperative chest radiographs demonstrated only a minor benefit as shown by a reduced degree of left band atelectasis in the OPCAB group.