Unexpected Subdiaphragmatic Findings on CT of the Chest in Septic Patients after Cardiac Surgery

Abstract Aim: to draw the attention to upper abdominal abnormalities, which may be revealed incidentally in patients referred for a chest computed tomography (CT) after cardiac surgery. MATERIALS AND METHODS: We reviewed prospectively and retrospectively the CT results of all patients referred for a chest CT, with suspected sternal infection or for other reasons, after cardiac surgery, to assess possible upper abdominal disease as visualized on lower cuts of the chest CT with abdominal windows. RESULTS: Out of a total of 205 patients in the study 39 (19%) had unexpected abdominal abnormalities. The organs involved in decreasing order of frequency were the spleen ( n  = 18), gallbladder ( n  = 15), pancreas ( n  = 9), kidneys ( n  = 6) and bowel ( n  = 3). Many patients had involvement of more than one organ. The lesions were mainly ischaemic and/or infectious in origin. These findings led to interventional procedures in 13 (33%) of the patients with a good outcome. CONCLUSIONS: We found a relatively high prevalence of abdominal abnormalities on CT of the chest in patients referred with suspected thoracic problems after cardiac surgery. Major findings on CT led to changes in the management of these patients. We recommend therefore viewing lung bases with abdominal windows as well as adding sections through the upper abdomen in patients who are referred for a chest CT after cardiac surgery with suspected thoracic problems. Apter, S. et al . (2002). Clinical Radiology 57 , 287–291.