Ultrasonography in the Diagnosis of Lung Adhesion before Surgery

The presence of pleural adhesions may render video-assisted thoracoscopic surgery difficult or impossible. The aim of this study was to assess the value of chest ultrasonography in the detection of pleural adhesions prior to thoracotomy.

Between 2009 and 2010, 42 consecutive patients undergoing thoracotomies (including video-assisted thoracic surgery) were evaluated with chest ultrasonography. These patients underwent a preoperative ultrasonic examination of the chest wall using a 7.5-10-MHz linear ultrasound probe at 7 points along the chest wall. We measured the movement of the visceral pleural slide.

In the upper thoracic wall, ultrasonography demonstrated a sensitivity of 63.0%, a specificity of 66%, a negative predictive value of 77%, a positive predictive value of 50.0%, and an overall accuracy of 65.0%. And for lower thoracic wall, ultrasonography demonstrated a sensitivity of 81.0%, a specificity of 59.0%, a negative predictive value of 89.0%, a positive predictive value of 44.0%, and an overall accuracy of 65.0%.

Chest ultrasonography is moderately accurate in detecting the presence and location of pleural adhesions. Use of preoperative chest sonographic findings to plan trocar placement and to determine the need for an open approach is valuable in helping prevent visceral injury and facilitating video-assisted thoracoscopic surgery.