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Flashcards in THORACIC Deck (13):
1

abscesses are more common on what side

right and present with an air-fluid level on imaging.

2

surgical indications to treat lung abscess include



if medical management does not clear the infection after 8 weeks,

large cavities over 4-6 cm,

hemoptysis,

ruling out malignancy.

3

Solitary pulmonary nodules

algorithm for any size:

If there is evidence that the nodule has been stable for over 2 years, then a follow up x-ray can be repeated in 1 year

If there is any change in character or size:
CT scan

Nodules that appear benign with smooth borders and a size less than 5mm:
may be followed with serial x-rays

The presence of calcification suggests:
benign nodule and a follow up chest x-ray is all that is indicated

If the doubling time is between one month and one year:
increased likelihood of malignancy

If the doubling time is over one year:
more likely benign.

patients who are over the age of 50:
50% chance of having some malignancy associated with the nodule

4

Superior Vena Cava (SVC) syndrome
most commonly due to
The diagnosis is often made by
treatment

most commonly due to an obstructing tumor that originates in the lung

The diagnosis is often made by

CT scan
bronchoscopy or needle biopsy may also be beneficial

The treatment for SVC syndrome is
CHEMO and RADIAITON!

Surgery is rarely possible due to the involvement of the major blood vessels.

5

Sequestrations represent malformations of the

lung in which there is usually no bronchial communication.


6

intralobar Sequestrations

reside within the lung parenchyma,

NOT asso with anomalies

BOTH systemic ARTERY supply

BOTH LEFT

intralobar medial or posterior segments of the lower lobes,

systemic artery arising from the infradiaphragmatic aorta and located within the inferior pulmonary ligament

venous drainage PULMONARY circ ( inferior pulmonary vein) but may also occur by way of systemic veins.

Because of the risk for infection and bleeding, intralobar sequestrations are usually removed, either by segmentectomy or lobectomy (NOT wedge)

More recently, CT and MRI have replaced the need for angiography and provide excellent mapping of the blood supply.

7

extralobar Sequestrations

IMMEDIATE symptoms infancy

has its own visceral pleura, and may even occur outside the thorax!

BOTH LEFT

BOTH artery supply systmemic

EXTRA lobar drains OUTSIDE of lung - systmeic venous

VENOUS drainage is mainly via the azygos-hemiazygos SYSTEMIC (80% of cases).

3 times more on left

ANOMOLIES in roughly 40% of cases - these are funky and can be entirely out of the chest

ASSO: posterolateral diaphragmatic hernia, eventration of the diaphragm, pectus excavatum and carinatum, enteric duplication cysts, and congenital heart disease.

8

normal aortic valves, the valve area

3.0 to 4.0 cm2.

9

percent narrowing of aortic valve needed to see clinical difference

orifice area falls by more than 50 percent.



10

Aortic stenosis should be treated with

valve replacement on an elective basis once symptoms of angina or syncope occur.

if present with symptoms of congestive heart failure:
emergent valve replacement.

Asymptomatic patients with a valve area less than or equal to 1.0 cm2:
surgical valve replacement

in children:
Balloon valvuloplasty has some effectiveness

NOT treatment of adults with aortic valve disease.

Bottom Line: Any symptoms related to aortic stenosis requires a replacement of the aortic valve.

11

Define severe aortic stenosis

1, 4, 40

valve area 4.0 m/sec

and/or

mean transvalvular gradient >40 mmHg

12

The thoracic duct course

the main lymphatic channel for the abdomen and chest.

Chylomicrons and long-chained fatty acids enter into this lymphatic system, whereas short and medium-chained fatty acids are transported in the portal system.

It originates at the cysterna chyli at L1-L2 and courses superiorly through the aortic hiatus. It runs along right of midline until crossing to the left at T4-T5. The duct then empties in to the left subclavian vein at the junction with the internal jugular vein.

Bottom Line: The thoracic duct crosses midline at T4-T5 and empties into the left subclavian vein.

13

small cell and squamous cel parneoplastic syndromes

Small cell
ADH
ACTH.

Squamous cell
PTH-related peptide