Lung Surgery Flashcards
(29 cards)
Diagnostic methods in lung disease
CT PET Lung function test Bronchoscopy Pleural aspiration Percutaneous biopsy Mediastinoscopy Thoracoscopy Anterior mediastinotomy Thoracotomy
CT
Invaluable for staging of bronchogenic carcinoma
PET
Evaluated for diagnostic accuracy for malignancy
Lung function test
Detailed portrait of the physiological effects of the particular chest disease, and be used to monitor disease or treatment
Bronchoscopy
Direct visualization & Biopsy (bronchial lesions or lung parenchyma (transbronchial biopsy))
Pleural aspiration
Pleural effusion aspiration and cytology
Percutaneous biopsy
X-ray or CT guidance
Mediastinoscopy
Biopsy paratracheal and sometimes subcarinal lymph nodes. Access to entire middle and posterior mediastinum except sub-aortic fossa. NB close to SVC, Innominate artery, aorta, recurrent laryngeal nerve
Thoracoscopy
Technique of choice for most pleural surgery (biopsy, pleurectomy, sampling of bull and evacuation of early empyema.; also for sampling of mediastinal lymph nodes and cervical sympathectomy.
Anterior mediastinotomy
Obtain tissue from lesions in anterior mediastinum (e.g., thyme tumors). Enter on left or right side of sternum
Thoracotomy
Full access for biopsy of paratracheal, subcarinal and hilar LN, the great vessels, esophagus, lung and pericardium
Pneumothorax - Classification
Closed pneumothorax: Pleural defect closes spontaneously –> fixed amount of air in pleural space
Open pneumothorax: Free passage of air via an open defect in the visceral pleura
Tension pneumothorax: pleural defect acts as a flap valve; allowing progressive entry of air.
Etiology of pneumothorax
Spontaneous - rupture of bull (young, lean, tall men)
Traumatic
Evaluation of Pneumothorax
Hx and PE - deviated trachea, dilated neck veins, dyspnea, absent breath sounds, or no signs. Pleuritic chest pain, trauma, hypoxia and hyper-resonance to percussion.
Tension pneumothorax –> Immediate TX!
CXR in other cases (expiratory film) (2 PROJECTIONS!!!)
Also CT?!
Treatment of Pneumothorax
- Semi sitting position
- Oxygen
- Aspiration of air (20 ml syringe)
- Chest tube if recurrence
- In tension pneumothorax: Large needle into the pleural space (2nd intercostal space midclavicular line). An apical chest drain position soon thereafter.
- Stapling of bullae
- Pleurectomy
Etiology of Excess pleural fluid
Transudate (35 g/L of protein) (due to leakage of capillaries)
- Infections
- Inflammation
- Primary lung cancers
- Metastatic cancer of breast
- Mesothelioma
Excess pleural fluid - Evaluation:
- Hx and PE: usually asymp or dyspnea, pleuritic chest pain, dull percussion, diminished breath sounds. Large effusions –> tracheal deviation
- X-ray: blunt costophrenic angles; larger= concave upper borders; Complete horizontal upper border = also air
- US: Identify presence of fluid and guiding of Dx or Tx aspiration
Excess pleural fluid - Management:
- Tx underlying cause
- Semi sitting position
- Oxygen
- Drainage if symptomatic. Best removed slowly (
Empyema - definition
Pleural fluid becomes infected, and pus accumulate in the pleural cavity. In early stages can be drained by intercostal tube w/ irrigation. In chronic cases a thick fibrous wall or cortex forms.
Empyema - Dx:
Diagnostic aspiration
Empyema - Tx:
Draining
Surgical removal
Hemothorax - etiology:
Following chest trauma
Following open chest surgery
Hemothorax - Evaluation
X-ray (2 projections!!!!)
US
Diagnostic aspiration/drainage
Hemothorax - management:
- Drain via 2 large drains, one apically and one basally.
- Clotted blood may need evacuation w/ a thoracoscope or thoracotomy
- Persistent or increasing drainage of blood indicated continuing intrathoracic bleeding which often need surgical correction.
