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The Proceedings of the American Thoracic Society 5:421-426 (2008)
© 2008 The American Thoracic Society
doi: 10.1513/pats.200802-017ET
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Radiographic Evaluation of the Potential Lung Volume Reduction Surgery Candidate

George R. Washko1, Eric Hoffman2 and John J. Reilly1

1 Brigham and Women's Hospital, Boston, Massachusetts; and 2 University of Iowa College of Medicine, Iowa City, Iowa

Correspondence and requests for reprints should be addressed to John J. Reilly, M.D., Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail: jreilly{at}partners.org

ABSTRACT

Delineating the extent and distribution of emphysema is an essential component of the evaluation of candidates for lung volume reduction surgery (LVRS). Imaging also may identify contraindications to LVRS, including bronchiectasis and pleural scarring. The chest X-ray is of limited utility in LVRS evaluation. Chest computed tomography (CT) scanning is an essential component of the evaluation, demonstrating the presence of emphysema and its amount and distribution. Clinical experience has shown that a substantial minority of chest CT scans will also demonstrate pulmonary nodules, some of which represent lung cancers. Published series, including the National Emphysema Treatment Trial, consistently demonstrate that patients with upper lobe predominant or heterogeneous emphysema are most likely to benefit from LVRS. Heterogeneity and distribution can also be assessed by radionuclide ventilation perfusion scanning, but this modality adds little additional information to CT scanning.

Key Words: emphysema • lung volume reduction surgery • CT scanning • pulmonary nodule • preoperative evaluation






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