Chest radiograph changes after cardiopulmonary bypass in children

To determine the spectrum of pediatric chest radiograph changes after cardiopulmonary bypass, 98 children (mean age = 5.9 yr, range 4 wk-16 yr) were studied for 3 days postoperatively. Daily A-P radiographs were evaluated for atelectasis, cardiomegaly, pleural effusions, diaphragmatic elevation, mediastinal widening, and pulmonary infiltrates. The overall incidence of atelectasis was 82%, with left lower lobe atelectasis the most common (64%). Right upper lobe atelectasis occurred in 35% of patients, far more common than in the adult. Radiographic changes were then compared with independent variables including patient weight, age, duration of bypass, and fluid balance by multiple linear regression. Pleural effusion correlated with patient weight and duration of bypass. Diaphragmatic elevation correlated with patient weight. Cardiomegaly correlated with patient age. Net fluid balance was a poor predictor of postoperative chest radiograph changes. We conclude that radiographic changes are common after cardiopulmonary bypass in children, that the overall incidence is not markedly different from adults, and that right upper lobe atelectasis occurs more frequently in children.