3 - Thoracic Surgery Flashcards
Stepwise approach to radiograph?
Adequacy Bones Cardiac silhouette Density Edema Foreign bodies
Infiltrate
Fluid in the lung
Effusion
Fluid in the pleural space
If the pt has pneumonia, what is the fluid in the infiltrate?
Pus
If the patient has pulmonary edema, the fluid in the infiltrate is:
Serous
If the patient has pulmonary contusion, the fluid in the infiltrate is:
Blood
Cavitation can be seen with what kinds of diseases?
TB
Fungal infection
What are blebs or bulla?
Thin-walled, contain air
Describe lung abscesses
Thick-walled cavity, contains fluid, inflammatory cells and organisms
Describe the presentation on CXR for pulmonary edema
Fluid “leaks” from the vessels into alveoli and lung tissues
cephalization
Bilateral perihilar infiltrates
Procedure to remove fluid of pleural effusion?
Thoracentesis
How will diaphragmatic hernia look?
No lung markings in the lower left lung field
Mediastinum is shifted to the right
Diaphragm is ruptured
Stomach is in left chest
Stomach is full of air
Needs surgery
Describe atelectasis
Collapsed alveoli
Cardiomegaly
Heart greater than 50% of the width of the chest
Possibly displaced PMI (left)
What causes Transudative fluid?
Increased vascular permeability or low osmotic pressure
CHF, liver failure
What causes Exudative fluid?
Usually inflammatory
CA, pneumonia
Thoracentesis
Needle drainage of pleural effusion
Thoracostomy
Chest tube
“S” in thoracostomy - Suck the fluid out
Pleurodesis
Used to scar the lining of the lung
Used in people that have recurrent effusions
ABX and cautery
Simple pneumo
“Collapsed” lung - with no change in vitals
Urgent txt to expand lung
Tension pneumo
Vital sign changes
Needle decompression then thoracostomy
Open pneumo
Penetrating
Sucking chest wound
Closed pneumo
Blunt trauma
Intact chest wall
Causes of spontaneous pneumo
Smoker Marfan’s Thin build Emphysema / blebs CF Lung CA
Causes of traumatic pneumo
Blunt chest trauma
Penetrating trauma
Barotrauma
Thoracic procedures
Txt for pneumo
Simple - thoracostomy
Tension - needle decomp
Open - one-way valve (chest seal), then thoracostomy
Closed - thoracostomy
Causes of pulmonary infiltrates and consolidation
Pneumonia Pulmonary contusion Inhalation injury Sepsis ARDS
Txt for pulmonary infiltrates
ABX
Antifungals
Ventilatory support
Aggressive pulm toilet
Lung masses that are touching bronchus can lead to
Cough / hemoptysis
Lung mass in pleura can lead to:
Chest wall pain
Lung masses that cause narrowing of the bronchus can lead to
Atelectasis
Lung masses in the mid parenchyma away from bronchus can lead to
Hemoptysis
NSCLC leads to what paraneoplastic syndrome?
Hypercalcemia
PTH-like substance is produced
Metastasis to the bone
Small cell lung cancer leads to what paraneoplastic syndrome?
ADH like substance
SIADH -> low serum Na
MSH production -> hyperpigmentation
ACTH production -> increased cortisol -> Cushings -> glucose intolerance
Pancoast tumor leads to what paraneoplastic syndrome?
Brachial plexus, cervical lymph chain
Ulnar nerve compression
Horner’s triad
SVC syndrome
Tissue dx of lung masses
Bronchio-alveolar lavage - inject saline, aspirate out and send for cytology
Trans-bronchial bioppsy - biopsy through bronchial wall
Endobronchial ultrasound — FNA of mediastinal nodes / mass
Percutaneous trans-thoracic biopsy
CT or fluoro guided - through chest wall
MC primary types of lung CA
Adenocarcinoma
Squamous cell carcinoma - often central
Common sites of metastasis
Lung
Liver
Bone
Brain
80% of solitary nodules are:
Infectious granulomas
TB or fungal infx
Benign lung masses
Less than 2cm Stable over 24 mos Concentric calcification Smooth border Solitary lesion
Malignant lung masses
More than 2cm Increased or unstable over 24 mos Irregular calcifications Spiculated border Multiple lesions
Unresectable
Tumor has invaded vital structures - can’t cut it out
Inoperable
Unstable pt due to comorbidities
Cancer staging
T - tumor size (cm)
N - nodal involvement
M - metastasis (y/n)
are you pleural effusion?
Cause i cant breath when youre around
