Radiology, surgery, and the pediatric chest.

Preoperative imaging of the tracheobronchial tree should focus on identifying the location, severity, and extent of tracheal narrowing, as well as possible causes of extrinsic compression. Plain film radiography and esophagography can be supplemented with CT or MR imaging for the evaluation of mediastinal masses or vascular abnormalities impinging on the airway. Surgical planning for the removal of intrathoracic tumors or cysts requires a detailed evaluation of the location and extent of the lesion, identification of encasement or compression of vital structures, and intraspinal extension to determine resectability and the need for neurosurgical consultation. Precise preoperative histologic diagnosis in most patients is not essential for surgical planning. Although the anatomic information provided by CT and MR imaging is comparable, MR offers the advantage of multiple imaging planes and allows the identification of intraspinal involvement of posterior mediastinal tumors or neuroenteric cysts without the use of intrathecal contrast agents. Conversely, MR imaging has little role in the assessment of pulmonary parenchymal abnormalities. These are best imaged with radiography and CT. Plain film radiography and contrast esophagography are often sufficient for the identification and delineation of postoperative complications in the chest. Complex air or fluid collections, however, may require further study with CT or ultrasonography for better characterization.