Thoracotomy and the contralateral lung. A study of the changes occurring in the dependent and contralateral lung during and after thoracotomy in lateral decubitus.

While examining and reporting on the radiographs taken routinely following all thoracic surgical procedures at St. Mary's Hospital, it was noted that in a high proportion of cases extensive and diffuse peripheral opacification was present in that hemithorax which was dependent and unopened during the thoracotomy, i.e., in the lung and/or pleural cavity contralateral to that of the surgical approach. This opacification was frequently observed in the immediate postoperative radiograph and, in a number of cases, in radiographs taken on subsequent days. The operations were undertaken for a variety of cardiac and pulmonary lesions which may be grouped as follows: (1) Mitral valvotomy; (2) miscellaneous cardiac operations, including aortic valvotomy, resection of coarctation of aorta, pericardiectomy, and congenital heart operations; (3) pneumonectomy and lobectomy for bronchial carcinoma; (4) miscellaneous pulmonary and pleural operations, e.g., pulmonary biopsy, lobectomy for bronchiectasis, abscess and tuberculoma, and pleurodesis. It was apparent that the opacification which had stimulated our interest was found only in those patients who had been in a lateral decubitus position for the whole of the duration of the operative procedures. For all these procedures, the position of the patient on the operating table was as shown in Fig. 1. The duration of the operations varied from one to three hours. These opacifications were dominantly peripheral and either widespread from apex to base or more localized, but at no time presented a segmental pattern or showed any well-defined margination (Figs. 2a and b). Further, the opacification did not appear to be associated in the earlier stages with any clinical evidence of pneumonia or 'pleurisy with effusions or with any untoward respiratory difficulty. The only physical sign noted in those patients showing such opacification was