The authors concluded that admission chest radiography was not warranted in patients without respiratory symptoms but could be considered in patients with an uncertain diagnosis who may present atypically, such as older patients, patients who are immunocompromised, or who cannot communicate symptoms with multiple comorbidities and uncertain diagnosis on admission. Malnik et al [12] conducted a retrospective investigation of medical records and found that a very small number of admission chest radiographs altered patient management if there was no clinical indication or abnormal physical examination finding. The authors concluded that a routine admission radiograph only altered management if there was a clinical indication for performance or abnormal physical examination findings in the thorax. Variant 2: Routine preoperative chest imaging for noncardiothoracic surgery. No 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. This is initially done by pulse oximetry, although CT chest with IV contrast may be pursued to exclude other causes of pulmonary disease [15]. CT Chest Without and With IV Contrast There is no relevant literature to support the use of CT chest without and with IV contrast for routine preoperative evaluation of patients without cardiopulmonary disease undergoing noncardiothoracic surgery.
Routine Chest Imaging. The authors concluded that admission chest radiography was not warranted in patients without respiratory symptoms but could be considered in patients with an uncertain diagnosis who may present atypically, such as older patients, patients who are immunocompromised, or who cannot communicate symptoms with multiple comorbidities and uncertain diagnosis on admission. Malnik et al [12] conducted a retrospective investigation of medical records and found that a very small number of admission chest radiographs altered patient management if there was no clinical indication or abnormal physical examination finding. The authors concluded that a routine admission radiograph only altered management if there was a clinical indication for performance or abnormal physical examination findings in the thorax. Variant 2: Routine preoperative chest imaging for noncardiothoracic surgery. No 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. This is initially done by pulse oximetry, although CT chest with IV contrast may be pursued to exclude other causes of pulmonary disease [15]. CT Chest Without and With IV Contrast There is no relevant literature to support the use of CT chest without and with IV contrast for routine preoperative evaluation of patients without cardiopulmonary disease undergoing noncardiothoracic surgery.