Omental flap in lung transplantation

Some surgeons performing lung transplantation will wrap the bronchial anastomosis with omentum in an attempt to improve healing. The authors retrospectively reviewed the chest radiographs and computed tomographic (CT) scans of 31 patients who underwent lung transplantation with bronchial omentopexy to determine the CT appearance of the intrathoracic omentum and the frequency and type of chest radiographic manifestations created by the omental flap. The omental flap was seen at CT in all patients, was predominantly of fatlike attenuation, and contained linear areas of increased attenuation representing omental vessels. In 16 patients (52%), a total of 29 chest radiographic findings that corresponded to the omental flap were seen. There was no statistically significant correlation between the type of operative procedure and the presence of a chest radiographic correlate for the omentum. The results showed that the omental flap is a potential diagnostic pitfall on post-lung transplantation chest radiographs; when there is confusion, however, the omentum can be identified with CT because of its attenuation value and characteristic course.