Flashcards in Thoracic And Cardiothoracic 1 Deck (21):
Patient with coin lesion on x-ray – chance of malignancy?
50% at 50 years of age (more likely if older, less likely if younger)
Characteristic of a benign lung lesion versus malignant lesion on imaging?
Smooth surface versus irregular/spiculated surface
Likely diagnosis if lung imaging shows:
2. Bull's-eye configuration
3. Popcorn appearance
1. Granulomas (Cancers rarely have calcium)
Noncancerous coin lesions are common where?
1. Southwest – coccidiomycoses
2. Ohio Valley – histoplasmosis
Patient presents with coin lesion – work up?
#CT guided needle aspiration
#If malignant/indeterminant, resection
60-year-old man with a 40 pack year smoking history presents with cough and hemoptysis. Absent breath sounds in the right lower chest. Normal labs. CXR shows 2 cm lesion in the right middle lobe and 2 cm lymph node at the take off from the right mainstem bronchus – next steps in the evaluation?
#Bronchoscopy to obtain tissue diagnosis
#Mediastinoscopy to examine lymph nodes
Doubling time of solitary pulmonary nodule that suggests cancer? That disfavors cancer?
Five weeks to 280 days
Less than five weeks for over 465 days
Likely diagnosis if pulmonary mess presents with:
1. Dental abscess or sinus
2. Concentric calcification
3. Thin-walled cavity with air fluid level
4. Chronic skin ulcers
5. Meningeal involvement
6. Mycetoma with air crescent sign
7. Well-defined border with slight lobulations
8. Adjacent to thickened pleura
8. Round atelectasis
55-year-old man with two PPD smoking history presents with hemoptysis and 10 pound weight loss. CXR shows 3.5 cm mass in right hilum. Bronchoscopy shows tumor in upper lobe bronchus. Mediastinoscopy is negative for lymph node metastasis. Histology shows undifferentiated squamous cell carcinoma. Stage? Management?
Stage I – no hilar metastasis
Exploratory thoracotomy and pneumonectomy because mass is centrally located
Stages for lung cancer?
Stage I – no lymph node involvement
Stage II – intrapulmonary and/or hilar lymph node involvement
Stage IIIa – over 3 cm tumor involving ipsilateral hilar and mediastinal lymph nodes
Stage IIIB – involvement of mediastinum and ipsilateral/contralateral mediastinal, hilar, supraclavicular lymph nodes
Treatment for stage I lung cancer?
Stage II lung cancer?
Stage III lung cancer?
Chemoradiation for surgical resection
Pancoast tumor – originates where?
Bad prognosis if?
Extreme apex of the long in the superior sulcus
CT scan, bronchoscopy, mediastinoscopy, needle Biopsy
Irradiation for six weeks, then surgical resection
Involvement of mediastinal nodes
25-year-old woman presents with cough, SOB, hemoptysis. Non-smoker. CXR reveals partial collapse of right upper lobe. Likely diagnosis? Confirm with? Treatment?
Bronchial adenoma resulting in atelectasis
CT scan, bronchoscopy
Why is bronchial adenoma a misnomer? Types?
Have malignant potential
Carcinoid (Oat-cell carcinoma) versus adenocystic
Danger in taking a biopsy of a bronchial adenoma?
Highly Vascular, tends to bleed
65-year-old retired shipyard worker presents with chest pain and shortness of breath for three months. Absent breath sounds and dullness to percussion in right lung base. CXR reveals opacified right lower lung field with pleural effusion – likely diagnosis? differential? Confirm with?
Plural effusion in older patient is cancer until proven otherwise
#Congestive heart failure
# viral/bacterial pneumonia
#Empyema or tuberculosis effusion
Thoracentesis and pleural biopsy
Treatment for mesothelioma?
Only cure – extrapleural pneumonectomy (removal of lung, parietal/visceral Flora, +/- pericardium and diaphragm)
Water-sealed chest tube mechanism?
Maintains negative pressure in plural space to create one-way valve drain air/fluid in lung
Patient gets the chest tube – causes of persistent air leak?
#Incorrect tube placement
#leaks from lung parenchyma, large bleb, bronchi
Patient with chest tube has persistent air leak – tube appropriately placed, leak from blend or bronchi ruled out – source of air leak? Management?
Parenchyma – surgical intervention
#Thorascopic excision of blebs and and Pleurodesis (pleural abrasion)