Thoracic Surgery

Question 1

Typical patient history?

Answer 1

Weight loss
Cough
Lethargy
Tachypnoea
Inappetence
+/- increased effort
Collapse

Question 2

PE ?

Answer 2

Chest wall mass
Decreased lung sounds
Muf ed heart sounds
Jugular venous distension
Ascites
Nothing

Question 3

What ddx for a cranial mediastinal mass

Answer 3

Thymoma
Lymphoma
Ectopic Thyroid
Extension of rib mass
(Branchial cyst)

Question 4

what views of thoracic radiographs?

Answer 4

• three views

Question 5

differentials for consolidated lung /lung mass?

Answer 5

neoplasia, FB, fungal infection, lung lobe torsion

Question 6

Respiratory compromise is caused by 2 mechanisms in pleural dx …?

Answer 6

1. Physical compression of the lungs in
   the thoracic space by fluid or air
2. Disassociation of the visceral and
   parietal pleura which prevents liquid
   coupling between the parietal and
   visceral pleura

Question 7

CLS of pleural dx?

Answer 7

Dyspnea
Increased abdominal effort
Cough
Rapid shallow breathing
No respiratory noise from upper airway
Decreased lung sounds on auscultation
Decompensate in lateral recumbency

Question 8

emergency management of pneumothorax / pleural effusion?

Answer 8

Oxygen
Blood gases if possible
Sedation?
Thoracocentesis
Chest Tube Placement when stable
Intermittent vs Continuous Suction

Question 9

Compare intermittent vs contagious chest tube drainage

Answer 9

Question 10

Traumatic pneumothorax?

Answer 10

Open vs closed
Tension pneumothorax

Question 11

Spontaneous pneumothorax?

Answer 11

• Bullae
• Neoplasia

Question 12

tx ofr traumatic pneumothorax?

Answer 12

Thoracocentesis
Chest Tube Placement
Intermittent vs Continuous Suction
Surgery - usually not necessary

Question 13

what causes of spontaneous pneumothorax?

Answer 13

Pneumothorax with no history of trauma
Leakage of air into the thoracic space:
Bullae
Neoplasia
Granuloma
Abscess

Question 14

Describe Bullae?

Answer 14

Large air spaces within lung parenchyma
Rupture and coalescence of alveoli

Question 15

Describe Bleb?

Answer 15

Accumulations of air between the visceral pleura
and the lung parenchyma
Rupture leads to leakage of air into the pleural
space

Question 16

Signallement for bullae cases?

Answer 16

large/ giant breed - young to middle aged

Question 17

Dx for bullae?

Answer 17

Anorexia, lethargy, Acute dyspnoea

Question 18

Dx of bullae?

Answer 18

Xray, CT fo thorax
May not definitiely rule out neoplasia until histopath of the affected lung is perfomed

Question 19

Tx of bullae - conservative vs surgical

Answer 19

Conservative ->
- Similar to traumatic penumothorax
- Unsuccessful in most cases

Surgical ->
- Median Sternotomy
- all lung lobes evaluated

Question 20

DDX for spontaneous pneumothorax?

Answer 20

ddx: neoplasia, granuloma, abscess

Question 21

tx for spontaneous pneumothorax?

Answer 21

thoracotomy (lateral approach or median sternotomy)

Question 22

Describe broadly incidence of primary lung tumors in dogg and cat?

Answer 22

RARE
Most malignant
High metastatic rate in cats

Question 23

What might primary ung tumors be?

Answer 23

• Carcinomas (adenoC) - SCC, malignant histiocyosis, sarcoma
• Well demarcated mass, caudal lobes

Question 24

Prognosis in primary tumors in dogs?

Answer 24

Question 25

Prognosis cats?

Answer 25

Question 26

Use of Lung CT?

Answer 26

Intra-pulmonary metastasis Metastasis to pulmonary LNs Approach and resectability of mass

Question 27

US-guided aspirate?

Answer 27

Depends on size and location of mass Do not perform if suspect abscess Dif cult if not adjacent to thoracic wall Reported success rate 80-90% Risk fo penumoT Necrosis and inflammation around tumour might make definitive diagnosis difficult

Question 28

Lung Lobe Torsion?

Answer 28

Signalement: Afghans, pugs - Torsion of right cranial ro middle lobes - Obstruction of lymphatics and veins - Effusion from the lung> modified transudate or chyle - CLS - Dyspnoea due to effusion

Question 29

VASCULAR RING Anomaly

Answer 29

Developmental abnormality of the aortic arches in which the oesophagus and trachea are encircled either completely or partially by vasculature

Question 30

6 most common heart defects?

Answer 30

- PDA - Pulmonic stenosis - Subaortic stenosis - Ventricular septal defect - Tetralogy of Fallot - Persiste,t right aortic arch

Question 31

Which vascular ring anomaly is most common? @

Answer 31

Persistent right aortic arch 90%

Question 32

CLS of vascular ring ?

Answer 32

- Regurg soon after eating solid food - Failure to thrive - Pyrexia, dyspnoea

Question 33

What surgical planning for thoracic surgery?

Answer 33

- Identify what exact abnormality present - Angiography or CT recommended

Question 34

What to do prior to surgery ?

Answer 34

- Pulmonary crackles / aspiration pneumonia - Oral amoxicillin, coupage, nebulisation - Often impossible to pass nasa-oesophageal tube - Feed small amounts from height - Keep upright for 10 minutes after feeding

Question 35

Approaches to thorax?

Answer 35

- Lateral/intercostal thoracotomy - Median sternotomy - Chest wall resection (thoracosopic)

Question 36

Prognosis for PDA ligation?

Answer 36

Treat before oesophageal nerve supply irreparably damaged - Repeat barrium swallow 4 months after surgery - Protracted cases poor prognosis

Question 37

Intercostal thoracotomy

Answer 37

Cut skin, very few muscles panniculus, (latissimus dorsi), scalenus, serratus ventralis, intercostal mm NO BONE Approach tumours of lung, heart, mediastinum Repair muscles only Chest drain Typically home in 1-3 days

Question 38

Median sternotomy

Answer 38

- Cut skin, re ect pectorals - STERNUM OSTEOTOMY - Approach tumours of lung and mediastinum - Repair sternum with suture or wire - Chest drain - Typically home in 3-4 days