Chest radiographic and CT findings after laser-assisted thoracic surgery

Laser-assisted thoracic surgery (performed through a thoracotomy or as an endoscopic procedure with thoracoscopy [pleural endoscopy]) is being used increasingly for lung-sparing resections of neoplasms, biopsies, and ablation of bullae. The technique is useful in treating patients who have limited pulmonary reserve and may avoid the problem of distortion of surrounding pulmonary tissue. Because laser energy causes injury to lung tissue, postoperative radiographs may show findings unique to the laser-assisted technique. The objective of this study was to determine postoperative radiographic findings common to laser-assisted surgery.

Pre- and postoperative and all follow-up chest radiographs were reviewed for 52 consecutive patients who had 60 laser-assisted thoracic surgical procedures (35 with an open thoracotomy, 25 with thoracoscopy) for resection of peripheral nodules (40), biopsy of focal (five) or diffuse (four) lung disease, or ablation of bullae (three). Postoperative chest CT studies available for 20 patients also were reviewed. All postoperative radiographic studies were evaluated for the presence and duration of pneumothoraces, pleural effusions, areas of parenchymal opacification or cavitation, and complications requiring surgical or radiologic intervention.

Pneumothoraces and pleural effusions were seen in 88% and 83% of cases, respectively, and were typically small, uncomplicated, and of limited duration. Nonspecific parenchymal opacification of various degrees was observed at the operative site in all cases and usually regressed within days or weeks to areas of parenchymal scarring. Parenchymal cavitation at the operative site occurred in 15 patients (29%). Eight patients (15%) had complications that required intervention, primarily prolonged air leaks and pleural space complications.

Radiographic findings after laser-assisted thoracic surgery are often nonspecific and of limited duration. In an asymptomatic patient, cavitation at the operative site is a normal finding related to the surgical technique and should not be misdiagnosed as infection or tumor. Radiographic findings normally resolve to stable cavitary or linear scars.