Ruolo della radiografia del torace nella valutazione preoperatoria della funzione polmonare dei pazienti con cirrosi candidati al trapianto di fegato

precoci. Parole Chiave: Radiografia del torace- malattie epatiche- scambi gassosi polmonarisindrome epatopolmonare. Abstract Purpose.To appraise the role of chest radiograph (CXR) in the clinical assessment of pulmonary complications that occur as a result of liver disease of any cause, a standardized reading of CXR has been compared with both results of lung function studies and severity of liver disease in 60 consecutive patients with cirrhosis candidates to liver transplant. Materials and methods. CXR were scored for signs of cardiomegaly, enlargement of central and or peripheral vessels, hyperkinetic circulatory and/or intravascular volume states, abnormally increased interstitial lung markings, pleural effusion by three independent observers. Results. The CXR score of this complete vascular-interstitial deficiency showed a highly interobserver reproducibility and was significantly increased in those patients with a more decompensated liver cirrhosis. Moreover an increased number of CXR signs of vascular and interstitial deficiency was present in those patients who had a more severe cirrhosis, as documented by the Child-Pugh score. Functional indices of pulmonary gas exchange and diffusing capacity were significantly impaired in patients with end-stage liver cirrhosis and in such a way they correlated also with the CXR score. In fact, lung function impairment was significantly less severe in patients with a CXR score lower than in those with a CXR score higher. 3 Conclusions.In conclusion, the information derived from a standardized reading of CXR is of valuable help in the clinical assessment of the pulmonary complications observed in the course of liver cirrhosis. When integrated with physiologic measurements, and in such instances with high resolution tomographic studies, chest radiography helps in discriminating those patients with advanced liver cirrhosis who need a proper therapeutic management.