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Post operative chest X ray after thoracoscopic resection for pulmonary malformation: Useless?

Arnaud Bonnard, Ahmed Kheniche, Marie Noelle Lebras, Dominique Berrebi, Alaa El Ghoneimi

Robert Debré Children University Hospital, Paris, France



Introduction: Surgery for pulmonary malformation can be complicated by ventilatory troubles, residual pneumothorax and pleural effusion. The aim of the study was to collect the post-operative radiographic findings looking for a correlation with the pulmonary status after surgery.
Patients and method: chest x ray at day post operative 2 (DPO 2) and 30 (DPO 30) of patients operated on for thoracoscopic pulmonary resection related to a congenital malformation between 2007 and 2012 were retrospectively reviewed. Only patients with congenital lobar emphysema (CLE), congenital cystic adenomatoid malformation (CCAM) and Intra lobar sequestration (ILS) were included. A post-operative finding’s classification in 4 grades of gravity (0,1,2 et 3) was built.
Results: 55 patients were operated on, 35 were included (26 CCAM, 8 CLE et 1 ILS). At DPO 2, 6 patients have lesions grade 0 and 1, 26 patients grade 2 and 3 patients grade 3. At DPO 30, 24 patients have stable grade 2 lesions (68.6%), while 10 were downgrading (28.6%) and only one upgrading (2.8%). Mean hospital stay was not different between patients classified in grade 0,1 or 2 (3,4 and 3 days respectively). Only patients classified as grade 3 on DPO2 have a longer hospital stay (8 days). With a median follow up of 23.5 months, 4 children (3 grade 2 and 1 grade 3) have a medical treatment for an asthma or recurrent bronchitis (11.4%).
Conclusions: Post-operative chest x ray is rarely normal after thoracoscopic pulmonary resection for pulmonary malformation. In two third of cases, it doesn’t improve at DPO 30. However, the mean hospital stay for grade 0,1 or 2 are quite similar meaning that the chest x ray in not an indication for prolonged hospital stay. Furthermore, lesions are not predictive of post-operative medical treatment requirement.