Thoracic Scars, Lobectomy and Pneumonectomy Flashcards
What are the possible indications for a lobectomy?
Bronchiectasis
Malignancy - early stage non-small cell lung cancer
Solitary pulmonary nodule
Cystic fibrosis
Tuberculosis
Lung abscess
What are the possible indications for a pneumonectomy?
Bronchiectasis
Malignancy involving proximal bronchi
Tuberculosis
Approach to lateral/posterior thoracotomy scar
- Asymmetical chest wall with absent ribs
- Thoracoplasty for PTB treatment in the past - Symmetrical chest wall, no deformity
- Lung transplant
- Pleurectomy (recurrent pneumothorax in EDS)
- Bullectomy
- Open biopsy
- Medistinal: repair of cardiopulmonary vessels, trachea, oseophagus, mediastinal tumours - Abnormal lung findings
- Hyperinflated: COPD with lung volume reduction surgery
- Reduced breath sounds
> Lobectomy (breath sound present in axilla)
> Pneumonectomy (no breath sound throughout)
- Lung transplant with complications - thoracotomy scar with clear breath sound - Clues to etiologies
- Finger clubbing - bronchiectasis, ILD, malignancy
- Tar staining - COPD, malignancy
- Palpable lymph nodes - malignancy
- Other side lung field - fine crepitations (ILD), coarse creps (bronchiectasis), wheeze (COPD) - Apex beat
- Percussion
What are the conditions that may necessitate lobectomy and splenectomy?
- Tuberculosis
- Sarcoidosis
What are the compensatory changes that occur after pneumonectomy/lobectomy?
- Occupying of the empty space
- Air fills space immediately after resection
- 80% of the space will be filled by fluid within 2 weeks - Elevation of hemidiaphragm
- Mediastinal shifting towards side of surgery
- Hyperinflation of remaining lung
What is pneumonectomy?
What is lobectomy?
Pneumonectomy - resection of entire lung
Lobectomy - resection of single lobe
How do you differentiate between lobectomy and pneumonectomy?
What are the indications for thoracotomy?
(M: ABBBBCDE)
Wedge resection, lobectomy, pneumonectomy, decortication, lung transplant
Lung Pathology
1. AFB (PTB) - which was treated with pneumonectomy in the past
2. Bleeding (massive haemoptysis)
3. Bronchiectasis (localised)
4. Biopsy (open biopsy)
5. Bullectomy
6. Cancer
7. Decortication of empyema or haemothorax
8. Excision of pleura (pleurectomy)
9. Lung transplant
Mediastinal Pathology
10. Repair of cardiopulmonary blood vessels
11. Surgery to trachea or oesophagus
12. Mediastinal tumour
What is this type of thoracic access used for?
Bilateral transverse sternotomy (clamshell scar)
Commonly in bilateral lung transplant
- CF, bronchiectasis, COPD, pulmonary fibrosis, sarcoidosis, AAT deficiency
(Unilateral transverse anterior sternotomy scar/Chamberlain procedure is used to access area lateral to aortic arch for LN, masses)
What is this type of small scar over the lateral thorax?
- Chest tube insertion
- Maybe VATS (usually posterior)
What is this type of small scar over the posterior thorax?
VATS scar
- Pleural or lung biopsy
- Decortication
- Pleurodesis
Differentiating tracheostomy scar and mediastinoscopy scar
Tracheostomy scar - transverse scar at midpoint between lower border of cricoid cartilage and suprasternal notch
Mediastonoscopy scar - just above suprasternal notch
For investigations of mediastinal lymphadenopathy
(technique largely superceded by endobronchial US)
- Sarcoidosis
- Tuberculosis
- Lymphoma
- Thymoma
- Malignancy staging
What type of small scar is this over the supraclavicular fossa?
Phrenic nerve crush scar - 2-4cm scar over supraclavicular fossa
(Obsolete treatment for PTB)
What type of scar is this over the posterior thorax?
Thoracoplasty
(Obsolete treatment for PTB, severe lung infection)
What is this scar?
Midline sternotomy scar
- CABG
- Open valve repair / replacement
What is this scar?
Anterior praecordial scar for pacemaker
(please palpate for pacemaker in situ)
