Postlobectomy Chest Radiographic Changes: A Quantitative Analysis

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Postlobectomy Chest Radiographic Changes: A Quantitative Analysis Choo-Won Kim, MD, MS, Alla Godelman, MD, Vineet R. Jain, MD, Avraham Merav, MD, Linda B. Haramati, MD, MS Canadian Association of Radiologists Journal Volume 62, Issue 4, Pages 280-287 (November 2011) DOI: 10.1016/j.carj.2010.12.005 Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 1 Radiographic measurements. Variables are expressed as Vi,j, where V is the variable being measured (T = chest cavity transverse measurement, C = chest cavity craniocaudal measurement, and M = distance from midline to mediastinal border), i represents the anatomic level (U = upper, M = mid, L = lower), and j represents the side (R = right, L = left). Canadian Association of Radiologists Journal 2011 62, 280-287DOI: (10.1016/j.carj.2010.12.005) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 2 Calculated postsurgical changes of the average transverse hemithorax length, craniocaudal hemithorax length, mediastinal shift, and hemidiaphragm elevation expressed in centimetres after different lobar resections. LUL = left upper lobe, LLL = left lower lobe, RUL = right upper lobe, RML = right middle lobe, RLL = right lower lobe. Canadian Association of Radiologists Journal 2011 62, 280-287DOI: (10.1016/j.carj.2010.12.005) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 3 Preoperative and immediate postoperative chest radiographs, depicting the changes associated with resection of the different lobes of the lung. (A) Preoperative posteroanterior (PA) chest radiograph of a 60-year-old woman with lung adenocarcinoma who underwent left lower lobectomy, demonstrating a nodular density in the left mid lung. (B) Immediate postoperative anteroposterior (AP) chest radiograph (B) of same patient as (A) after left lower lobe resection, demonstrating minimal shift of the mediastinum towards the left, marked ipsilateral hemidiaphragm elevation, and a clearly decreased size of the ipsilateral hemithorax. (C) Preoperative PA chest radiographs of a 69-year-old woman with lung adenocarcinoma who underwent left upper lobectomy, demonstrating a lobulated left upper lobe mass and midline sternal wires from prior open heart surgery. (D) Immediate postoperative AP radiograph of the same patient (C) after left upper lobe resection, demonstrating a marked shift of the upper mediastinum to the left, with minimal displacement of the lower mediastinum, slight ipsilateral hemidiaphragm elevation, and decreased volume of the ipsilateral hemithorax. (E) Preoperative PA chest radiographs of a 67-year-old man with lung adenocarcinoma who underwent right lower lobectomy, demonstrating findings consistent with prior open heart surgery but no obvious masses (computed tomography showed 2 small irregular right lower lobe nodules). (F) Immediate postoperative AP radiograph of the same patient (E) after right lower lobe resection, demonstrating marked upper and lower mediastinal shift towards the right, marked ipsilateral hemidiaphragm elevation, and significantly decreased volume of the right hemithorax. (G) Preoperative PA chest radiographs of a 77-year-old man with lung adenocarcinoma who underwent right upper lobectomy, showing a nodule within the periphery of right upper lobe. (H) Immediate postoperative AP chest radiographs of same patient (G) after right upper lobe resection, demonstrating marked shift of upper mediastinum towards the surgical side with perihilar prominence, significant ipsilateral hemidiaphragm elevation, and decreased volume of the ipsilateral hemithorax. Canadian Association of Radiologists Journal 2011 62, 280-287DOI: (10.1016/j.carj.2010.12.005) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 4 Progression of relative chest cavity measurements (expressed as a ratio of postoperative values to preoperative ones) in the first 12 months after lobectomy. Canadian Association of Radiologists Journal 2011 62, 280-287DOI: (10.1016/j.carj.2010.12.005) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 5 Relative mediastinal shift (expressed as a ratio of post- to preoperative values) in the first 12 months after lobectomy. Canadian Association of Radiologists Journal 2011 62, 280-287DOI: (10.1016/j.carj.2010.12.005) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions