HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: 2232010721v1 223/2/468    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Padley, S. P. G. Articles by Hansell, D. M. Search for Related Content PubMed PubMed Citation Articles by Padley, S. P. G. Articles by Hansell, D. M.

Asymmetric ARDS Following Pulmonary Resection: CT Findings—Initial Observations¹

¹ From the Departments of Radiology (S.P.G.P., D.M.H.), Surgery (P.G.), Critical Care Medicine (S.J.J.), and Respiratory Medicine (A.U.W.), Royal Brompton Hospital, Fulham Rd, London SW3 6NP, England. Received April 4, 2001; revision requested May 23; revision received August 13; accepted September 28. Address correspondence to S.P.G.P. (e-mail: s.padley@ic.ac.uk).

PURPOSE: To investigate whether asymmetric distribution of acute respiratory distress syndrome (ARDS) following lobectomy is due to compensatory hyperexpansion of the residual lung within the hemithorax operated on and to discern if this distribution reflects true asymmetry of the disease process.

MATERIALS AND METHODS: Retrospective review of the intensive care unit database was performed over a period of 6 years to identify all cases of lung injury following lung surgery that satisfied the American-European consensus criteria for ARDS. Time to onset following surgery, time of subsequent computed tomographic (CT) examination, patient age and sex, and nature of surgery were recorded, as well as eventual patient status (ie, death or discharge). Availability of both preoperative and postoperative CT scans was required for inclusion for further analysis. These images were analyzed on a commercial CT workstation for the volume of lung resected and the pre- and postoperative volume and density of each lung. Expected postoperative densities (preoperative density adjusted for volume) were compared with observed postoperative densities.

RESULTS: Review disclosed 583 patients who underwent lobectomy or segmentectomy. Seventeen patients (2.9%) developed postoperative ARDS. Nine of these patients had pre- and postoperative CT scans available for analysis. In eight of nine cases, density increased more in the nonoperated lung than in the operated lung (P = .01). The degree of density increase in the nonoperated lung was significantly greater (305 mg/mL; range, 48–449 mg/mL) than that in the operated lung (13 mg/mL; range, -198 to 231 mg/mL; P < .001).

CONCLUSION: Following lobectomy, there appears to be a truly asymmetric form of ARDS rather than compensatory hyperexpansion of the residual lung on the operated side.

© RSNA, 2002

Index terms: Lung, injuries, 60.413, 60.452, 60.453 • Lung, surgery, 60.413, 60.452, 60.453 • Respiratory distress syndrome, adult (ARDS), 60.413

This article has been cited by other articles:

				A. L. Lagan, G. J. Quinlan, S. Mumby, D. D. Melley, P. Goldstraw, G. J. Bellingan, M. R. Hill, D. Briggs, P. Pantelidis, R. M. du Bois, et al. Variation in Iron Homeostasis Genes Between Patients With ARDS and Healthy Control Subjects Chest, June 1, 2008; 133(6): 1302 - 1311. [Abstract] [Full Text] [PDF]

				N. Alam, B. J. Park, A. Wilton, V. E. Seshan, M. S. Bains, R. J. Downey, R. M. Flores, N. Rizk, V. W. Rusch, and D. Amar Incidence and Risk Factors for Lung Injury After Lung Cancer Resection Ann. Thorac. Surg., October 1, 2007; 84(4): 1085 - 1091. [Abstract] [Full Text] [PDF]

				T. Schilling, A. Kozian, M. Kretzschmar, C. Huth, T. Welte, F. Buhling, G. Hedenstierna, and T. Hachenberg Effects of propofol and desflurane anaesthesia on the alveolar inflammatory response to one-lung ventilation Br. J. Anaesth., September 1, 2007; 99(3): 368 - 375. [Abstract] [Full Text] [PDF]

				E. J. Chae, J. B. Seo, S. Y. Kim, K.-H. Do, J.-N. Heo, J. S. Lee, K. S. Song, J. W. Song, and T.-H. Lim Radiographic and CT Findings of Thoracic Complications after Pneumonectomy RadioGraphics, September 1, 2006; 26(5): 1449 - 1468. [Abstract] [Full Text] [PDF]

				K. Ichikado, M. Suga, H. Muranaka, Y. Gushima, H. Miyakawa, M. Tsubamoto, T. Johkoh, N. Hirata, T. Yoshinaga, Y. Kinoshita, et al. Prediction of Prognosis for Acute Respiratory Distress Syndrome with Thin-Section CT: Validation in 44 Cases Radiology, December 1, 2005; 238(1): 321 - 329. [Abstract] [Full Text] [PDF]