A large, multicenter study found that preoperative radiographs performed in patients undergoing noncardiothoracic surgery rarely influenced the decision to undergo surgery [5]; in fact, 25.7% of cases proceeded to surgery before the radiology report was even available [5]. The authors also found wide variability in the use of preoperative chest radiography between different surgical departments, despite clinical risk factors for cardiopulmonary disease. Patients undergoing evaluation for abdominal solid organ transplant (eg, liver or kidney) are known to have higher rates of intrathoracic diseases, including coronary artery disease, pleural effusions, pulmonary hypertension, and hepatopulmonary syndrome, which may not be clinically apparent [13,14]. In a study of 341 patients being evaluated for liver transplantation, Bozbas et al [20] determined that 48% of patients had an abnormal chest radiograph. Other studies have shown that increasing severity of liver disease correlates to the degree of abnormality on chest radiography [14]. Currently, the American Association for the Study of Liver Diseases recommends screening of liver transplant candidates for hepatopulmonary syndrome. This is initially done by pulse oximetry, although chest radiography may be pursued to exclude other causes of pulmonary disease [15]. Variant 3: Routine preoperative chest imaging for noncardiothoracic surgery. History of chronic cardiopulmonary disease or cardiothoracic surgery. Initial imaging. CT Chest With IV Contrast Patients undergoing evaluation for abdominal solid organ transplant (eg, liver or kidney) are known to have higher rates of intrathoracic diseases, including coronary artery disease, pleural effusions, pulmonary hypertension, and hepatopulmonary syndrome, which may not be clinically apparent [13,14]. Currently, the American Association for the Study of Liver Diseases recommends screening of liver transplant candidates for hepatopulmonary syndrome.
Routine Chest Imaging. A large, multicenter study found that preoperative radiographs performed in patients undergoing noncardiothoracic surgery rarely influenced the decision to undergo surgery [5]; in fact, 25.7% of cases proceeded to surgery before the radiology report was even available [5]. The authors also found wide variability in the use of preoperative chest radiography between different surgical departments, despite clinical risk factors for cardiopulmonary disease. Patients undergoing evaluation for abdominal solid organ transplant (eg, liver or kidney) are known to have higher rates of intrathoracic diseases, including coronary artery disease, pleural effusions, pulmonary hypertension, and hepatopulmonary syndrome, which may not be clinically apparent [13,14]. In a study of 341 patients being evaluated for liver transplantation, Bozbas et al [20] determined that 48% of patients had an abnormal chest radiograph. Other studies have shown that increasing severity of liver disease correlates to the degree of abnormality on chest radiography [14]. Currently, the American Association for the Study of Liver Diseases recommends screening of liver transplant candidates for hepatopulmonary syndrome. This is initially done by pulse oximetry, although chest radiography may be pursued to exclude other causes of pulmonary disease [15]. Variant 3: Routine preoperative chest imaging for noncardiothoracic surgery. History of chronic cardiopulmonary disease or cardiothoracic surgery. Initial imaging. CT Chest With IV Contrast Patients undergoing evaluation for abdominal solid organ transplant (eg, liver or kidney) are known to have higher rates of intrathoracic diseases, including coronary artery disease, pleural effusions, pulmonary hypertension, and hepatopulmonary syndrome, which may not be clinically apparent [13,14]. Currently, the American Association for the Study of Liver Diseases recommends screening of liver transplant candidates for hepatopulmonary syndrome.