Utility of the sliding lung sign for the prediction of preoperative intrathoracic adhesions

Abstract

Background: To assess the potential of the ultrasonographic sliding lung sign to detect severe intrathoracic adhesions before surgery. Methods: This was a prospective, single-center, observational study including all patients aged 20-89 years undergoing elective thoracic surgery. Patients with pneumothorax, pyothorax, hemothorax, chylothorax, and hydrothorax were excluded. We recorded the ultrasound sliding lung sign, surgical characteristics, and follow-up parameters: past medical history, respiratory function, chest X-ray findings, and computed tomography (CT) findings. Severe intrathoracic adhesion was defined as the need for adhesiolysis requiring more than 30 minutes. Results: A total of 168 patients consented to participate. All 15 patients without the sliding lung sign had hard severe adhesions [specificity 100%, sensitivity 88.2%, positive predictive value (PPV) 100%, negative predictive value (NPV) 98.7%, and area under curve (AUC) 0.94]. There were two false-negative results, both of which were soft adhesions. Although blunting of the costophrenic (CP) angle, CT findings, past medical history, and restrictive lung disease were identified as significant risk factors of severe intrathoracic adhesion, all areas under the curve were low (0.71, 0.71, 0.69, 0.61, respectively). Thoracotomy frequency, intraoperative bleeding, operative time, and postoperative hospitalization were significantly greater in these patients than in those with non-severe adhesions. Conclusions: The ultrasound sliding lung sign could be used to predict severe intrathoracic adhesions before surgery. Preoperative confirmation of the ultrasound sliding lung sign is important for planning surgical approaches and implementing appropriate safety management.

Effectiveness and failure factors of manual aspiration using a small needle for large pneumothorax in stable patients

“…Chest tube insertion is complicated by the presence of adhesions, which are likely if the lung apex does not collapse (18,19). As adhesions are difficult to detect on chest radiography, and computed tomography is not always available, chest ultrasonography is the most effective imaging technique to detect intrathoracic adhesions (31) and can also be used to diagnose pneumothorax (32).…”

“…Patients were placed in the decubitus position with the diseased side up or in the supine position if the decubitus position resulted in worse pain or dyspnea. Chest ultrasonography was performed to confirm intrathoracic adhesions and the distance from the skin to the pleural space at the puncture site (31,32). The size of the intravenous needle was chosen according to the depth of the intrathoracic space.…”

Advances and safe use of energy devices in lung cancer surgery

“…In lung cancer surgery, severe adhesions were subdivided into three groups depending on the location: whole thoracic cavity, locally invasive, and vascular sheath adhesions. Chest ultrasound sonography is useful for assessing adhesions throughout the thoracic cavity [ 67 , 68 ]. Cine MRI would be effective in imaging areas not accessible by ultrasonography.…”

Preoperative Lung Ultrasound to Detect Pleural Adhesions: A Systematic Review and Meta-Analysis

“…The high specificity of lung ultrasound supported the diagnosis of pleural adhesions with certainty, and the absence of a sliding sign indicated dense rather than loose pleural adhesions [ 15 ]. This information may be used to identify high-risk patients in order to prepare the patient and medical team for prolonged surgeries and the associated complications [ 2 ].…”