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Flashcards in Cardiothoracic 2 Deck (11):
0

55-year-old woman presents with regurgitation chewed, digested food. Long history of dysphasia. Suspected diagnosis? Confirm with? Specific location? Treatment?

Pharyngeal (Zenker) diverticulum; barium swallow or endoscopy

Between lower pharyngeal constrictor and cricopharyngeal muscle

Transection of cricopharyngeal muscle to prevent uncontrolled contraction

1

45-year-old develops progressive SOB and weakness following respiratory illness. CXR shows a large heart shadow and congested lungs. ECHO reveals EF of 20% with moderate mitral regurgitation. Cardiac catheterization shows normal coronary arteries with poor ventricular contraction – likely diagnosis? Prognosis? Treatment?

Dilated cardiomyopathy (probably related to viral respiratory illness)

One third recovered, one third stay the same, one food dye

#Steroids, diuretics, immunosuppressives
#Beta blockers
#Heart Transplant

2

Second location of pulsion diverticulum?

Distal esophageal gastric junction (epiphrenic diverticulum)

3

Etiology of alcalasia? Treatment?

Loss of smooth muscle ganglionic cells of Auerbach plexus

Heller myotomy (100% effective) or transesophageal dilation (60% effective)

4

Location of squamous cell carcinoma of the esophagus?

Upper and middle third of the esophagus

5

Staging of esophageal tumors based on? Determine staging with what tests

Wall penetration and lymph nodes spread

Endoscopic ultrasound; CT scan

6

Treatment for cervical/upper third esophageal cancer?

#Chemoradiation
#If persists, resection

7

Treatment for cancer in the middle of the esophagus?

Neoadjuvant chemotherapy, then surgical resection

8

Treatment for esophageal cancer in the lower third the esophagus?

Esophagectomy and proximal gastrectomy

9

Patient presents with severe dysphasia and difficulty swallowing. Weight loss if 50 lbs. Coughs constantly - work up? Likely reason for cough? Treatment?

Barium swallow, esophagoscopy, biopsy

Chronic aspiration from TE from tumor erosion into trachea

Cancer progressed too far for curative procedure – palliative care (feeding gastrostomy, stent, radiation, palliative resection)

10

Most likely tumor in the anterior mediastinum? Other tumors?

Thymoma (surgical resection)

Teratoma, lymphoma (Radiation and chemotherapy)