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J Thorac Cardiovasc Surg. 2018 May;155(5):2035-2040. doi: 10.1016/j.jtcvs.2017.12.124. Epub 2018 Feb 1.

Frequency of abnormal findings on routine chest radiography before cardiac surgery.

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Department of Radiology, University Medical Center, Utrecht, The Netherlands. Electronic address:
Department of Cardiothoracic Surgery, University Medical Center, Utrecht, The Netherlands.
Department of Radiology, University Medical Center, Utrecht, The Netherlands.
Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.



Preoperative chest radiograph screening is widely used before cardiac surgery. The objective of this study was to investigate the frequency of abnormal findings on a routine chest radiograph before cardiac surgery.


In this retrospective cohort study, 1136 patients were included. Patients were scheduled for cardiac surgery and underwent a preoperative chest radiograph. The primary outcome was the frequency of abnormalities on the chest radiograph. Secondary outcome was the effect of those abnormalities on surgery.


One half of the patients (570/1136; 50%) had 1 or more abnormalities on the chest radiograph. Most frequent abnormalities were cardiomegaly, aortic elongation, signs of chronic obstructive pulmonary disease, vertebral fractures or height loss, possible pulmonary or mediastinal mass, pleural effusion, and atelectasis. In 2 patients (2/1136; 0.2%), the chest radiograph led to postponement of surgery, whereas in none of the patients the surgery was cancelled. In 1 patient (1/1136; 0.1%) the surgical approach was altered and in 15 patients (15/1136; 1.3%) further analysis was performed without having an impact on the planned surgical approach.


Although abnormalities are frequently found on preoperative chest radiographs before cardiac surgery, change in clinical management with regard to planned surgery or surgical approach occurs infrequently.


aortic calcification; cardiac surgery; chest radiograph; chest x-ray; preoperative imaging

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