Clinical Value of Routine Chest Radiography and Point-of-Care Lung Ultrasound Following Ambulatory Thoracic Sympathectomy

NCT07854340 | Not Yet Recruiting

• 1 other identifier: Pendant
• Study Type: observational
• Target: 200
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this observational study is to find out whether routine chest X-rays after surgery actually change patient care, and whether lung ultrasound could be a suitable alternative for detecting important postoperative findings in adults undergoing same-day bilateral thoracic sympathectomy for primary hyperhidrosis or facial flushing. The main questions it aims to answer are: How often does a routine postoperative chest X-ray change clinical management? Can lung ultrasound detect relevant postoperative findings as effectively as chest X-ray? Researchers will compare lung ultrasound results and the treatment decision that would have been made based on ultrasound alone with the actual treatment decision based on chest X-ray to see if using lung ultrasound first, with chest X-ray only when needed, could reduce radiation exposure and imaging costs without affecting care. Participants will: Have a routine chest X-ray after surgery. Have a lung ultrasound exam in the recovery unit before the chest X-ray result is known. Have their postoperative care recorded based on the actual chest X-ray result. Be monitored for short-term outcomes after discharge.

Conditions

Pneumothorax Iatrogenic Postprocedural

Keywords

thoracic surgery; PocUS; PNEUMOTHORAX; LUNG SLIDING

Outcome Measures

Primary Outcomes (2)

• Lung US

  Features of Lung US examination; Presence the lung sliding in 2D mode and seashore sign in M-mode. The probe will be placed in 3 points of examination per side according blue protocol for lung US ( anterior area, mid anterior and postero lateral ).

  In PACU area using Sonosite US with curve probe. During the first 30 minutes after extubation.

• Chest X-RAY

  Chest X-RAY report by radiologist with the presence of one of the following: Visceral Pleural Line: A crisp, thin, hair-like white line contouring the edge of the lung parenchyma, separated from the inner thoracic wall. Absence of Bronchovascular Markings: The peripheral space between the visceral pleural line and the chest wall (the pleural space) is hyperlucent (pure black) and completely devoid of pulmonary vessels and lung architecture. Increased Volume / Shift of the Collapsed Lung: The underlying lung shrinks toward the hilum, becoming denser (more radiopaque) as alveolar air decreases.

  In PACU during the first 30 minutes after extubation with portable X-ray equipment.

Study Arms (1)

Patient after sympathectomy

Participants will: Undergo a routine postoperative chest X-ray as part of the current standard of care. Receive an additional lung ultrasound examination performed by the treating anesthesiologist on arrival in the recovery unit, before the chest X-ray result is available. Have the anesthesiologist record the hypothetical clinical decision that would have been made based only on the ultrasound findings. Be followed for postoperative outcomes, including unplanned hospitalization, emergency consultation within 24 hours, and pleural intervention or readmission within 30 days

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The study population consists of adult patients aged 18 years or older who are scheduled to undergo outpatient bilateral thoracic sympathectomy for primary hyperhidrosis or facial flushing, with same-day discharge planned. The study is focused on patients treated in a single institution under routine clinical practice, where postoperative chest X-ray is part of the current standard of care. Only patients who provide written informed consent are included. This population is intended to represent ambulatory adults undergoing elective bilateral thoracic sympathectomy, while excluding patients with conditions that could interfere with standardized postoperative lung ultrasound assessment or alter the usual outpatient pathway, such as previous thoracic surgery, significant chest wall deformity, or intraoperative complications requiring hospitalization.

You may qualify if:

• Adults aged 18 years or older with a scheduled bilateral thoracic sympathectomy for primary hyperhidrosis or facial flushing.
• Same-day discharge surgery planned.
• Signed informed consent.

You may not qualify if:

• Previous ipsilateral or bilateral thoracic surgery.
• Chest wall deformity
• Intraoperative conversion.
• Complication requiring hospitalization.
• Technically non-interpretable ultrasound examination in both hemithoraces.

Sponsors & Collaborators

• Clinica Alemana de Santiago: lead

Study Sites (1)

Clínica Alemana Santiago

Santiago, Chile

Location

Related Publications (5)

• Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest. 2012 Mar;141(3):703-708. doi: 10.1378/chest.11-0131. Epub 2011 Aug 25.

  PMID: 21868468 BACKGROUND

• Winberg C, Prager R, Kim CS, Meyer M, Arntfield R. Comparative evaluation of lung ultrasound versus chest X-ray for pneumothorax assessment post-invasive intrathoracic procedures: A case-costing evaluation. Medicine (Baltimore). 2025 Apr 25;104(17):e41959. doi: 10.1097/MD.0000000000041959.

  PMID: 40295252 BACKGROUND

• Ranganath L, Gowda D, G N M. Diagnostic Accuracy of Point-of-Care Ultrasound in Detecting Pneumothorax: A Systematic Review and Meta-Analysis. Cureus. 2026 Jan 2;18(1):e100652. doi: 10.7759/cureus.100652. eCollection 2026 Jan.

  PMID: 41635328 BACKGROUND

• Porter ED, Kelly JL, Fay KA, Hasson RM, Millington TM, Finley DJ, Phillips JD. Reducing Unnecessary Chest X-Ray Films After Thoracic Surgery: A Quality Improvement Initiative. Ann Thorac Surg. 2021 Mar;111(3):1012-1018. doi: 10.1016/j.athoracsur.2020.05.161. Epub 2020 Jul 30.

  PMID: 32739255 BACKGROUND

• Galata C, Cascant Ortolano L, Shafiei S, Hetjens S, Muller L, Stauber RH, Stamenovic D, Roessner ED, Karampinis I. Are Routine Chest X-rays Necessary following Thoracic Surgery? A Systematic Literature Review and Meta-Analysis. Cancers (Basel). 2022 Sep 7;14(18):4361. doi: 10.3390/cancers14184361.

  PMID: 36139521 BACKGROUND

MeSH Terms

Conditions

Pneumothorax

Condition Hierarchy (Ancestors)

Pleural Diseases; Respiratory Tract Diseases

Central Study Contacts

ALONSO BLANCH, MD

CONTACT

+56934600652; blanchx4@gmail.com

JAVIERA VARGAS, MD, MSc

CONTACT

+56957383772; jpvargasz@gmail.com

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Target Duration: 1 Month
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Staff anesthesiologist. PocUS certificate.

Study Record Dates

• First Submitted: August 20, 2026
• First Posted: October 2, 2026
• Study Start: October 1, 2026
• Primary Completion (Estimated): July 31, 2027
• Study Completion (Estimated): October 31, 2027
• Last Updated: October 2, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

CL (1)