Flashcards in 35. Non-Lung Cancer Thoracic Surgery Deck (46):
What are the main medical conditions that require a non-lung cancer thoracic surgery? (10)
1. lung abscess
2. empyema thoracic
3. pleurectomy _decortication
4. thymic tumours
5. tracheal surgery
6. benign lung tumours
8. bullous lung disease
10. lung transplant (e.g. in CF)
What is a lung abscess?
- collection of pus in a body cavity surrounded by granulation and necrotic tissue
- made up of tissue fluid, bacteria, neutrophils, pus (dead infected tissue)
What can cause a lung abscess? (5)
1. aspiration, including foreign body
3. PTE; pulmonary thromboendarterectomy (removes thrombus from pulmonary arteries)
4. Lung calcium
5. septic emboli
What is the body's natural response to a lung abscess?
- immune system will form granulation tissue and will begin to scar (collagen tissue)
Why can patients with lung abscesses sometimes cough up pus?
abscess may rupture the pleural cavity, cause pain or find way to main airway
What main feature of the pus can indicate a lung abscess?
the bad smell of pus; due to anaerobic bacteria
What are treatment options for a lung abscess?
1. antibiotics or antifungals prescribed
2. postural drainage; mucus and pus removed
3. bronchoscopy for drainage/removal of pus
4. surgery (if abscess doesn't respond to antibiotics and infected lobe needs to be removed or drained)
What is empyema thoracic?
pus in the pleural cavity
What is empyema mainly caused by? (2)
98% due to pneumonia (but lung abscess can also cause it)
What are the most common causes for empyema thoracic? (6)
4. upper abdominal related
What is lung decortication pleurectomy?
- surgical procedure which removes the surface layer or fibrous cover/membrane of an organ (lungs can be covered by inelastic, thick peel which needs to be removed as it restricts lung expansion)
- pleurectomy= removal of affected pleura lining is removed
Patient with what type of cancer often have pleurectomy and decortication?
What group of people may face complication with pleurectomy and decortication procedure?
Elderly; especially with COPD as peeling process will not heal which can be fatal
Is all of pleura removed in a pleurectomy and decortication?
No, only enough to make lungs expand again (not all of it can be taken off as parts of it are attached to diaphragm and heart)
What is the aim of pleurectomy and decortication surgery?
to allow lungs to expand again
What are thymic tumours caused by? (5)
3. thymic carcinoma
4. carcinoid tumours of the thymus
Where in the mediastinum does the thymus lie?
Anterior superior mediastinum (in front of heart and behind the sternum)
What is the function of the thymus?
- factory for maturing t cells (which are also produced in bone marrow)
- trains and develops t cells
What happens to the thymus at puberty?
It begins to shrink and by the age of 40/50 disappears completely forming fat
What is the most benign thymic tumour?
What is the most metastatic thymic tumour?
thymic carcinoma (has lymphoid and epithelial components)
What are the main tracheal surgeries?
1. repair of iatrogenic injury
2. tracheal tumours (salivary gland tumours and squamous carcinomas)
What are the most common carcinomas in smokers and non-smokers in tracheal cancers?
- in non-smokers it's adeno-cystic carcinoma
- in smokers it's squamous carcinoma
What are common benign lung tumours? (7)
4. neural tumours
Why should benign tumours be removed as quickly as possible?
They can unexpectedly grow to large sizes and do more damage
What is a primary pneumothorax?
- cause is unknown
-occurs spontaneously especially in young people
What is a secondary pneumothorax?
- patient has underlying lung disease e.g. COPD or emphysema
What are 2 forms of a pneumothorax?
What is a persistent pneumothorax often caused by?
Often a ruptured bulla( sac over 2cm)
Bulla: dilated air space in the lung parenchyma (cellular tissue of organs)
What is an open pneumothorax?
-Involves unsealed opening in the chest wall which impairs breathing (lungs hang out of the chest due to the hole)
- If hole diameter is bigger than trachea (2cm), then air will flow through hole and not trachea which can be fatal
What is a tension pneumthorax?
- when air is escaping from lung tissue into pleural cavity and cannot return
- leads to accumulation of air
- causes high pressure volume expansion and compression of underlying ling and shift of mediastinal structures to one side of the chest
What causes bilateral tension pneumothorax?
If tension pneumothorax pushes organs to opposite hemithorax and can impair venous return to the heart as well as cause a pneumothorax
What are indications for surgery in pneumothorax? (3)
3. sometimes after one episode
What are 2 surgeries for a pneumothorax?
1. pleurodesis; sticking/adhering two membranes together with talc to prevent build up of fluid in pleural cavity
2. pleurectomy; removal of part of pleura to prevent build up of fluid in the affected area
What other condition in lungs can pleurodesis be used for?
What cancer type in lungs involves pleurectomy?
mesothelioma (pleural mesothelial cancer)
Are bronchogenic cysts present from birth?
Yes, they are congenital malformations of the bronchial tree
How do bronchogenic cysts cause symptoms?
they press on the trachea and oesophagus and cause compression
What are bronchogenic cysts collectively known as?
foregut duplication cysts (most common type of foregut duplication cysts)
What are the most common causes of needing a lung transplantation? 93)
1. cystic fibrosis
2. pulmonary fibrosis (idiopathic)
What occurs in pulmonary fibrosis?
- air sacs become scarred
- lungs become stiff and not stretchable
What are common acquired and infective causes of bronchiectasis? (4)
2. cystic fibrosis (v. common)
3. immune system problems
What age range is restricted for lung transplantation?
What are lung transplantations restrictions? (6)
1. age <65
2. not overweight
3. not diabetic
4. no renal failure
5. no mental illness
6. good social support
What is the mortality rate of a single lung transplantation?