Lung volume reduction surgery (LVRS) is an emerging promising palliative treatment option for select patients with severe, debilitating pulmonary emphysema. It usually involves bilateral wedge resection of 20-30% of the most diseased lung through a median sternotomy. It has been proposed that LVRS reduces size mismatching between the hyperinflated lungs and chest cavity, which in turn restores outward circumferential pull on bronchioles (increasing elastic recoil) and improving expiratory airflow dynamics.
Pre-operative suitability is often assessed with a thoracic CT scan. This should also be complimented by relevant clinical factors (e.g presence of severe ischemic heart disease etc) and respiratory function assessment.
Radiographic parameters used in assessing suitability
Factors that are generally thought to be favorable factors for LVRS include
- heterogenous pattern of emphysema - patients with large upper lobe lesions: respond better to LVRS than patients with small uniformly distributed disease 3.
- higher percentage of normal and mildly emphysematous lung at CT 6.
- younger age 8
Factors that are considered relative contraindications to LVRS include
- clinically significant bronchiectasis 7
- presence of pleural disease 7
- presence of unsuspected interstitial disease 7
- presence of an increapulmonary mass or concerning nodule.
- presence of pulmonary hypertension 8
- presence of severe airways disease 8
- presence of a profound thoraic wall deformity such as a a severe kyphosis 8
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