Thoracic Surgery, C71 P621-648 Flashcards Preview

Section III Subspecialty Surgery P517 > Thoracic Surgery, C71 P621-648 > Flashcards

Flashcards in Thoracic Surgery, C71 P621-648 Deck (267)
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1

What does VATS stand for?
P621

Video-Assisted Thoracic Surgery

2

THORACIC OUTLET SYNDROME (TOS)
What is it?
P621

Compression of the:
Subclavian artery
Subclavian vein or
Brachial plexus at the superior outlet
of the thorax

3

THORACIC OUTLET SYNDROME (TOS)
What are the causes (3)?
P621

1. Various congenital anomalies,
including cervical rib or abnormal
fascial bands to the first rib, or
abnormal anterior scalene muscle
2. Trauma:
Fracture of clavicle or first rib
Dislocation of humeral head
Crush injuries
3. Repetitive motor injuries (baseball
pitchers)

4

THORACIC OUTLET SYNDROME (TOS)
What are the symptoms?
P621

Paresthesias (neck, shoulder, arm, hand);
90% in ulnar nerve distribution
Weakness (neural/arterial)
Coolness of involved extremity (arterial)
Edema, venous distension, discoloration
(venous)

5

THORACIC OUTLET SYNDROME (TOS)
What are the most common
symptoms with TOS?
P621

Neurologic

6

THORACIC OUTLET SYNDROME (TOS)
Which nerve is most often
involved?
P621

Ulnar nerve

7

THORACIC OUTLET SYNDROME (TOS)
What are the signs?
P622

Paget-von Schroetter syndrome—venous
thrombosis leading to edema, arm
discoloration, and distension of the
superficial veins
Weak brachial and radial pulses in the
involved arm
Hypesthesia/anesthesia
Occasionally, atrophy in the distribution
of the ulnar nerve
Positive Adson maneuver/Tinel’s sign
Edema

8

THORACIC OUTLET SYNDROME (TOS)
What is the Adson
maneuver?
P622

Evaluates for arterial compromise
Patient:
1. Extends neck (lifts head)
2. Takes a deep breath and holds
3. Turns head toward examined side
Physician:
Monitors radial pulse on examined side
Test finding is positive if the radial
pulse decreases or disappears
during maneuver

9

THORACIC OUTLET SYNDROME (TOS)
What is Tinel’s test?
P622

Tapping of the supraclavicular fossa
producing paresthesias

10

THORACIC OUTLET SYNDROME (TOS)
What is the treatment?
P622

Physical therapy (vast majority of cases)
Decompression of the thoracic outlet by
resecting the first rib and cervical rib
(if present) if physical therapy fails
and as a last resort

11

CHESTWALL TUMORS
BENIGN TUMORS
What are the most common
types?
P622

1. Fibrous rib dysplasia (posterolateral rib)
2. Chondroma (at costochondral
junction)
3. Osteochondroma (any portion of rib)

12

CHESTWALL TUMORS
BENIGN TUMORS
What is the treatment?
P622

Wide excision and reconstruction with
autologous or prosthetic grafts

13

CHESTWALL TUMORS
MALIGNANT TUMORS
What are the most common
types?
P623

1. Fibrosarcoma
2. Chondrosarcoma
3. Osteogenic sarcoma
4. Rhabdomyosarcoma
5. Myeloma
6. Ewing’s sarcoma

14

CHESTWALL TUMORS
MALIGNANT TUMORS
What is the treatment?
P623

Excision with or without radiation

15

CHESTWALL TUMORS
MALIGNANT TUMORS
What is Tietze’s syndrome?
P623

Noninfectious costochondral cartilage
inflammation

16

DISEASES OF THE PLEURA
PLEURAL EFFUSION
What is it?
P623

Fluid in the pleural space

17

DISEASES OF THE PLEURA
PLEURAL EFFUSION
What are the causes?
P623

1. Pulmonary infections (pneumonia)
2. Congestive heart failure (CHF)
3. SLE or rheumatoid arthritis
4. Pancreatitis (sympathetic effusion)
5. Trauma
6. Pulmonary embolism
7. Renal disease
8. Cirrhosis
9. Malignancy (mesothelioma,
lymphoma, metastasis)
10. Postpericardiotomy syndrome

18

DISEASES OF THE PLEURA
PLEURAL EFFUSION
What are the symptoms?
P623

Dyspnea, pleuritic chest pain

19

DISEASES OF THE PLEURA
PLEURAL EFFUSION
What are the signs?
P623

Decreased breath sounds, dullness to
percussion, egophony at the upper limit

20

DISEASES OF THE PLEURA
PLEURAL EFFUSION
What are the properties of a
transudate?
P623

Specific gravity <3 g/dL
Few cells

21

DISEASES OF THE PLEURA
PLEURAL EFFUSION
What are the properties of
an exudate?
P623

Specific gravity >1.016
Protein >3 g/dL
Many cells

22

DISEASES OF THE PLEURA
PLEURAL EFFUSION
What is the key diagnostic
test?
P624

Thoracentesis (needle drainage) with
studies including cytology

23

DISEASES OF THE PLEURA
PLEURAL EFFUSION
What is the treatment?
P624

1. Pigtail catheter or thoracostomy (chest
tube)
2. Treat underlying condition
3. Consider sclerosis

24

DISEASES OF THE PLEURA
PLEURAL EFFUSION
What is an empyema?
P624

Infected pleural effusion; must be
drained, usually with chest tube(s)
Decortication may be necessary if the
empyema is solid

25

DISEASES OF THE PLEURA
PLEURAL EFFUSION
What is a decortication?
P624

Thoracotomy and removal of an infected
fibrous rind from around the lung (think
of it as taking off a fibrous “cortex” from
the lung)

26

DISEASES OF THE PLEURA
LUNG ABSCESS
What are the signs/
symptoms?
P624

Fever, sputum, sepsis, fatigue

27

DISEASES OF THE PLEURA
LUNG ABSCESS
What are the associated
diagnostic studies?
P624

CXR: air-fluid level
CT scan to define position and to
differentiate from an empyema
Bronchoscopy (looking for
cancer/culture)

28

DISEASES OF THE PLEURA
LUNG ABSCESS
What is the treatment?
P624

Antibiotics and bronchoscopy for culture
and toilet, with or without surgery

29

DISEASES OF THE PLEURA
LUNG ABSCESS
What are the indications for
surgery?
P624

Underlying cancer/tumor
Refractory to antibiotics

30

DISEASES OF THE PLEURA
LUNG ABSCESS
What are the surgical
options?
P624

Lobectomy of lobe with abscess
Tube drainage