Cardiothoracic Flashcards
Segments in the right lung
10 total
upper lobe: apical, posterior, anterior
middle lobe: medial, lateral
lower lobe: superior, anterior basal, lateral basal, medial basal, posterior basal
segments in the left lung
8 total
upper lobe: apico-posterior, anterior
lingula: superior, inferior
lower lobe: superior, anteromedial basal, lateral, posterior
most common pulmonary vein anatomy variant
separate vein draining the right middle lobe (30%)
What population gets lung cancer screening CT?
asymptomatic
age 55-80
30 pack year history
currently smoke or quit within past 15 years
differential for feeding vessel sign?
septic emboli
hematogenous mets
most common location for bronchial atresia
apico-posterior segment of left upper lobe
what is associated with horseshoe lung?
scimitar syndrome
what spares the costophrenic angles?
- pleural plaques
- LCH
- hypersensitivity pneumonitis
What can mimic alpha 1 antitrypsin/ pan lobular emphysema
IV ritalin use
Vanishing lung syndrome
idiopathic cause of giant bullous emphysema, results from avascular necrosis of the lung parenchyma and hyper inflation
- favors bilateral upper lobes
- defined as bullous disease occupying at least 1/3 of a hemithorax
- most common in young men
Ddx for perilymphatic nodules
- silicosis
- sarcoidosis
- lymphangitic spread of cancer
Ddx for centrilobular nodules
- RB- ILD
- infection
- hypersensitivity pneumonitis
Ddx for random nodules
- miliary TB
- mets
- fungal infection
DDx for Atoll (Reverse halo)
- Organizing pneumonia
- fungal pneumonia
- TB
- Wegener’s
- pulmonary infarct
Williams Campbell syndrome
congenital cystic bronchiectasis from deficeincy of cartilage in 4th-6th order bronchi
when is a superior sulcus tumor unresectable?
- involvement of brachial plexus above T1
- diaphragm paralysis (C3,4,5)
- greater than 50% of vertebral body
- distal nodes or mets
Hughes Stovin syndrome
- recurrent thrombophlebitis and pulmonary artery aneurysm formation and rupture
ddx for CHF in newborn
- TAPVR (infracardiac)
- congenital aortic or mitral stenosis
- hypoplastic left heart
- cor triatriatum
- Infantile (pre-ductal) coarctation
ddx for small heart
- Addison’s disease
- cachectic state
- constrictive pericarditis
associations with PDA
- prematurity
- Maternal rubella
- cyanotic heart disease
Holt Oram
hand/thumb defects +ASD
Norwood procedure
- when is it done?
- what does the procedure entail?
- within days of birth (HLHS)
- tiny aorta is anastomosed to pulmonary trunk and arch is augmented with a graft
- ASD is enlarged
- PDA is ligated (to prevent overshunting)
- BT shunt between Right subclavian artery and right pulmonary artery
Sano procedure
- same as norwood, but using conduit to connect right ventricle to pulmonary artery instead of a B-T shunt
Glenn
- Classic
- Bi directional
Classic: SVC to Right pulmonary artery (end to end)
bidirectional: shunt between SVC and right pulmonary artery (end to side); RPA is left open, letting blood flow to both lungs
Fontan
Glenn + closure of ASD + shunt between right atrium to left PA
complications of Fontan
- right atriomegaly and arrhythmia
- plastic bronchitis
Blalock Taussig shunt
- classically done for TOF
- shunt between sublcavian artery and pulmonary artery
- done on opposite side of ortic arch
- modified B-T shunt uses a Gortex shunt
Rastelli procedure
- used to correct TGA, pulmonary outflow obstruction, or VSD
- VSD used as the LVOT - baffle is placed in RV to divert flow as VSD to aorta
- pulmonary valve is oversewn and conduit is inserted between RV and PA
Jatene procedure
- aorta and pulmonary trunk are transected at level of sinuses and switched so that LV becomes systemic ventricle
- coronaries are removed and re-implanted to new aorta (PA)
- no conduit used
Ross procedure
- used for disease aortic valves in children
- native pulmonary valve is used to replace the aortic valve
- cyroperserved pulmonary valve homograft is used to replace pulmonary valve
Bentall procedure
composite graft replacement of aortic valve, aortic root, and ascending aorta with re-implantation of coronary arteries into graft
- used to treat combined aortic valve and ascending aorta disease, including Marfans
