Cardiothoracic Surgery in Non Malignant Situations

Question 1

What is a lung abscess?

Answer 1

Collection of pus surrounded by granulation tissue

Question 2

How does a lung abscess come about?

Answer 2

Aspiration of foreign body
Pneumonia
PTE
Lung cancer
Septic emboli

Question 3

How does pneumonia lead to lung abscess?

Answer 3

Infection causes necrotion of tissue developing into an abscess
The lung try’s to discharge pus and it usually bursts into the pleural space causing empyema
- Sudden onset of severe pleuritic chest pain
- Swinging fever

Question 4

How can lung abscesses be treated?

Answer 4

Via a drain inserted into the abscess cavity to drain pus/fluid

Question 5

What is an empyema throacic?

Answer 5

Where pus spreads throughout the pleural cavity

Question 6

How can an empyema thoracic be caused?

Answer 6

Post pneumonic
Post operative
Oesophageal
Upper abdominal related
Osteomyelitis
Post traumatic

Question 7

How can oesophageal problems cause empyema?

Answer 7

Vomiting with relaxation of lower oesophageal sphincter and corresponding spasm of upper oesophageal sphincter.
- Leads to rupture of the oesophagus
- Discharges vomit into pleural cavity
- Gives rise to fatal empyema
- Vomiting then chest pain!

Question 8

What is the aim of a pleurectomy and decortication?

Answer 8

Aim is to peel off parietal and visceral pleura from the accessible portions of the chest wall and lung surface to allow the lung to expand to its normal size (never full size but 80-90%).

Question 9

What is a thymoma?

Answer 9

Malignant tumour, type a-c

Question 10

What is a thymolipoma?

Answer 10

Combination of a thymoma and lipoma

Question 11

What is a thymic carcinoma?

Answer 11

Most severe type of thymic tumour
Tends to invade surrounding structures

Question 12

What is the prognosis for thymic carcinomas?

Answer 12

Often inoperable as invade into mediastinum and structures like vena cava, heart and aorta

Question 13

What are the types of thymic tumours?

Answer 13

Thymoma
Thymolipoma
Thymic carcinoma
Carcinoid tumours of the thymus
Lymphoma

Question 14

When would you perform tracheal surgery?

Answer 14

Repair of iatrogenic injury
Tracheal tumours

Question 15

How do iatrogenic injuries occur?

Answer 15

If/when anaesthetist passes endotracheal tube through wall of the trachea

Question 16

What are some tracheal tumours?

Answer 16

Salivary gland tumours
Squamous carcinoma

Question 17

What are some benign lung tumours?

Answer 17

Hamartoma
Fibroma
Lipoma
Neural tumours
Papillomas
Chondroma

Question 18

What is hamartoma?

Answer 18

Proliferation of cells usually found in that organ.
So in the lung proliferation of epithelial cells, cartilage and fat.

Question 19

What are neural tumours?

Answer 19

Associated with intercostal nerves, sympathetic trunk, vagus or phrenic nerves.
Should be removed as have pre-malignant potential (10%).

Question 20

What makes a pneumothorax primary?

Answer 20

No underlying abnormality of the lung
Caused by a developmental defect usually only affecting a small portion of the lung, usually the apex.

Question 21

What makes a pneumothorax secondary?

Answer 21

Widespread pathology throughout lung
Usually COPD or pulmonary fibrosis

Question 22

What is the operation status of primary/secondary pneumothoraxes?

Answer 22

Primary = operable
Secondary = usually non-operable

Question 23

Define recurrent and persistent?

Answer 23

Recurrent = goes away then comes back
Persistent = doesn’t go away

Question 24

What is an open pneumothorax?

Answer 24

Physical hole in the chest wall
Air goes in via the hole not the trachea

Question 25

What is the outcomes of an open pneumothroax?

Answer 25

Ineffective ventilation leading to quick Ventilatory failure

Question 26

What is the treatment for an open pneumothroax?

Answer 26

Rag soaked in water to be put over the hole Prevents air from being being sucked in

Question 27

What does a pneumothorax result in?

Answer 27

Results in lung/lobar collapse

Question 28

What is a tension pneumothorax?

Answer 28

Air escapes into the pleural space on inspiration but doesnt return on expiration. Causing pressure to build up and cauing complete collapse of the lung.

Question 29

What does a tension pneumothorax cause?

Answer 29

Mediastinal structures to shift to opposite side

Question 30

What is tension pneumothorax associated with?

Answer 30

Flying and diving

Question 31

What is the prognosis of tension pneumothorax?

Answer 31

Often fatal as becomes bilateral (fatal within 10-15 minutes)

Question 32

What are the treatment options for a pneumothorax?

Answer 32

- If bulla seen then staple it and disconnect it from the lung - stops air escaping from that section. - Sterile talcum powder injected into pleural cavity - allows sides of pleura to stick together - pleurodesis.

Question 33

What is a bulla?

Answer 33

A large abnormal airspace in the lung > 2cm in diameter

Question 34

What happens to bulla when you fly?

Answer 34

They can increase in size - Severe pain - Pneumothorax - Tearing of pulmonary veins - Air can transmit from bulla to pulmonary veins to heart and end up in brain causing a stroke (cerebral air embolism).

Question 35

How are bulla treated?

Answer 35

Via operation and removal of bulla

Question 36

What are the indications for surgery in pneumothorax?

Answer 36

Recurrence (if had 2 or more surgery recommended). Persistence (drain still leaking after air 7 days). Sometimes after one episode depending on person and lifestyle.

Question 37

What types of surgery are done for pneumothroax?

Answer 37

Pleurodesis Pleurectomy

Question 38

What are bronchogenic cysts?

Answer 38

Congenital lesions Belonging to a group known as foregut duplication cysts.

Question 39

What causes bronchogenic cysts?

Answer 39

Symptoms pressing on trachea or oesophagus Such as: - Stridor - Dysphagia - Life threatening

Question 40

What is the pathology of bronchogenic cysts?

Answer 40

Mucous lake doesnt join with rest of bronchial tree and thus forms a duplication cyst

Question 41

Where are bronchogenic cysts usually located?

Answer 41

Around the trachea or carina

Question 42

Why would you perform a lung transplant?

Answer 42

Cystic fibrosis Pulmonary fibrosis Emphysema

Question 43

What type of transplant is done in CF patients?

Answer 43

Double lung transplant

Question 44

What type of lung transplant is done in pulmonary fibrosis patients?

Answer 44

Single lung transplant - lower risk For young people do double lung transplant

Question 45

What are some conditions for getting a lung transplant?

Answer 45

Age < 65 years Not overweight Not diabetic No renal failures No mental illness Good social support

Question 46

What are the mortality rates for single/double lung transplants?

Answer 46

Single = 5-10% Double = 10-20%