Routine Preoperative Chest Research Articles

The Value of Routine Preoperative Chest Roentgenograms in Infants and Children

FARNSWORTH, P. B.; STEINER, E.; KLEIN, R. M.; SANFILIPPO, J. A.; Moffitt, Emerson A. M.D. Author Information

Value of the Chest X-Ray as a Screening Test for Elective Surgery in Children

A retrospective study was conducted to assess the value of the chest x-ray as a preoperative screening procedure in pediatric patients. Admissions for elective surgery were compared at two hospitals, one that required routine preoperative chest x-rays and one that did not. Our purpose was to determine the yield of the screening chest x-ray in detecting unknown abnormalities and to determine whether patients who had a preoperative chest x-ray taken experienced fewer anesthetic or postoperative complications than did those who did not. In all, 1,924 cases were studied; in 749 a preoperative chest film was taken. Of those 749 cases, a previously unsuspected abnormality was discovered in 35 (4.7%) patients. Nine (1.2%) of these abnormalities were considered to be clinically significant and three (0.4%) resulted in cancellation of surgery. No differences in anesthetic or postoperative complications were noted between the two groups of patients. It is recommended that the performance of routine preoperative chest x-rays on apparently healthy children be discontinued.

The Value of Routine Preoperative Chest Roentgenograms in Infants and Children

The charts and routine preoperative roentgenograms of 350 children admitted for elective pediatric surgery were analyzed to evaluate the clinical importance of routine preoperative chest roentgenograms. This analysis, and a review of the literature, should indicate that routine preoperative roentgenograms for elective pediatric surgery are unnecessary. Indications for selected preoperative roentgenograms based on patients' history and clinical findings are enumerated.

The value of routine preoperative chest roentgenograms in infants and children

The value of routine preoperative chest roentgenograms in infants and children

Left atrial wall calcification on computed tomography

Thoracic CT scan, without intravenous iodinated contrast media, was performed on a patient with left arial wall calcification that was diagnosed previously on the conventional chest films. The CT scan appearance of this entity was shown. The exact display of the location and extension of the calcifications, and the additional detection of mitral valve calcification, suggest that a routine preoperative chest CT scan could be of value with cardiac patients.

Routine Pre-Operative Chest Radiography. 1977 Compared with 1955 at Peterborough District General Hospital

Routine pre-operative chest X-rays have been taken for 22 years. There has been recent criticism of this investigation. 1000 such X-rays taken in 1977 are compared with the same number in 1955. It appears now that routine pre-operative chest X-rays are not necessary under 30 years of age but that they are essential over that age.

VALUE OF PREOPERATIVE CHEST X-RAY EXAMINATIONS IN CHILDREN

To assess the value of routine preoperative chest x-ray films in pediatric patients, a prospective study of 1,500 patients, ages newborn to 19 years, was undertaken. Of all the patients, 7.5% demonstrated at least one roentgenographic abnormality, with 4.7% of the patients demonstrating a totally unsuspected significant roentgenographic anomaly. In 3.8% of the patients, surgery was eihter postponed or cancelled or the anesthetic technique was altered as a result of the roentgenographic finding. It is believed that the routine preoperative chest film is justified if the film is evaluated before surgery and the results clinically followed up.

Value of Preoperative Chest X-ray Examinations in Children

To assess the value of routine preoperative chest x-ray films in pediatric patients, a prospective study of 1,500 patients, ages newborn to 19 years, was undertaken. Of all the patients, 7.5% demonstrated at least one roentgenographic abnormality, with 4.7% of the patients demonstrating a totally unsuspected significant roentgenographic anomaly. In 3.8% of the patients, surgery was eihter postponed or cancelled or the anesthetic technique was altered as a result of the roentgenographic finding. It is believed that the routine preoperative chest film is justified if the film is evaluated before surgery and the results clinically followed up.

Points from Letters: Routine preoperative chest radiography

Points from Letters: Routine preoperative chest radiography

Letter: Routine preoperative chest radiography.

Letter: Routine preoperative chest radiography.

Routine preoperative chest radiography in non-cardiopulmonary surgery.

Preoperative radiography was performed on 667 consecutive patients undergoing elective non-cardiopulmonary surgery in a large hospital in Wales. Of all significant findings reported 54% were due to cardiomegaly and 19% to chronic respiratory disease, and no appreciable abnormality was found in any patient under 30. Out of a subsample of 152 examined prospectively, 38% had received a chest radiograph within the last year, and the maximum marrow dose had been exceeded in 12-5%. It is concluded that the procedure, as presently practised, is not only being considerably overused but is also exposing many recipients to the potentially harmful effects of over-irradiation. The findings provide further evidence in support of the Royal College of Radiologists' proposal that a national multicentre study of diagnostic radiology should be set up with some urgency.

Metastatic carcinoma.

<h3>To the Editor.</h3> —In a recent clinicopathologic case report, "Metastatic Carcinoma Simulating a Postoperative Endophthalmitis" (Arch Ophthal<b>83</b>:59-60,1970), Levine and Williamson described a patient who developed a hypopyon one month after cataract extraction. Three months later, when the patient died, metastatic bronchogenic carcinoma in the iris was noted. The article left several important questions unanswered: Was the preoperative medical review of systems positive for respiratory or neurological complaints, a history of recent weight loss, or other symptoms suggestive of metastatic disease? Did the preoperative physical examination reveal any evidence of pulmonary or metastatic disease? Were the preoperative laboratory examinations suggestive of an ocult malignancy (anemia, abnormal liver function tests, elevated serum calcium level, etc)? What did the routine preoperative chest roentgenogram reveal? At the time the hypopyon was noted, were cervical or other lymph nodes palpable? What was the extent of the primary tumor? What other organs were involved

Ossified bronchial adenoma

A case of bronchial adenoma is reported which presented radiologically as an extensively calcified hilar mass on a routine chest radiograph of a patient undergoing surgery for varicose veins. This is of interest because, although bronchial adenomas may present in this way (Zellos, 1962; Baldwin and Grimes, 1967), calcification is not regarded as one of their radiological features. A man aged 25 years was admitted to the University Hospital of the West Indies for treatment of a localised mass of varicose veins in his left leg. Apart from the abnormal veins, he was symptomless and had no abnormal physical signs. A routine pre-operative chest radiograph demonstrated a calcified mass at the right hilum (Fig. 1). No other abnormality was seen. Tomographic examination confirmed the presence of a hilar mass containing calcification which was peripheral and also within the mass (Fig. 2). The lesion was presumed to be a large calcined tuberculous hilar gland. Bronchoscopy was then performed and, close to the origi...

ROUTINE PREOPERATIVE CHEST RADIOGRAPHY ANALYSIS OF 1000 CASES

ROUTINE PREOPERATIVE CHEST RADIOGRAPHY ANALYSIS OF 1000 CASES