Cardiothoracic surgery and non-malignant lung situations

Question 1

What are the causes of a lung abscess?

Answer 1

Aspiration (incl. foreign bodies)

Inadequately treated pneumonia

Pulmonary thromboembolism

Lung cancer

Septic emboli

Question 2

What does a lung abscess look like on a CXR?

Answer 2

Thin layer of granulation tissue forming the cavity

Liquid inside (often not filled entirely the way up)

Important to note the position the patient was in for the CXR as the pus inside the cavity will sit differently

Question 3

What is the treatment for a lung abscess?

Answer 3

Surgical insertion of chest drain

Probably given a fuck ton of antibiotics as well

Question 4

What would a burst lung abscess likely form?

Answer 4

Empyema

Question 5

What is an empyema thoracis?

Answer 5

Collection of pus in the pleural cavity

Type of pleural effusion

Question 6

What are the causes of an empyema?

Answer 6

Post-operative

Post-trauma

Post-pneumonic

Oesophageal

Upper abdominal related

Osteomyelitis

Question 7

How is empyema treated?

Answer 7

Chest drain

Then pleurectomy & decortication procedures

Question 8

What is a pleurectomy?

Answer 8

Operation to remove a thin layer of fibrous tissue from the surface of the lungs

Question 9

What is a decortation?

Answer 9

Operation to remove a thin layer of fibrous tissue form the inner surface of the ribs

Question 10

What is the purpose of the pleurectomy and decortation?

Answer 10

In the wise words of Jack pechey:

They do it to remove infected tissue if antibiotics and chest drain doesnt work

Question 11

What and where is the thymus?

Answer 11

Thymus gland - part of the endocrine and the lymphatic system

Located in the mediastinum, deep to the sternum

Question 12

What are some examples of thymic tumours?

Answer 12

Thymoma

Thymolipoma

Thymic carcinoma

Carcinoid tumours of the thymus

Lymphoma

Question 13

Of the thymic tumours, which ones are/can be cancerous?

Answer 13

Thymoma - either benign or malignant

Thymic carcinoma
Carcinoid tumours of the thymus
Lymphoma

Question 14

What are the types of surgeries of the trachea?

Answer 14

Repair of iatrogenic injury

Tracheal tumours:

• Salivary gland tumours
• Squamous carcinoma

Question 15

What are the types of benign tumours of the lung?

Answer 15

Hamartoma
Fibroma
Lipoma
Neural tumours
Papillomas
Chondroma
(Carcinoid)

Question 16

Why is carcinoid tumour not technically benign?

Answer 16

It is malignant, but is very slow growing so can be considered benign in some contexts

Question 17

What is a neurofibroma?

Answer 17

Benign tumour of the cells and tissues covering nerves

Question 18

Although benign, how might a intrathoracic neurofibroma cause problems?

Answer 18

Can grow to a large size and displace alveoli n stuff

Question 19

What is a haemopneumothorax?

Answer 19

Blood and air in pleural cavity

Question 20

What is Bullous lung disease?

What do they look like on a CXR?

Answer 20

Large bullae (blister things) in the lungs

Look like large black holes on a CXR

Question 21

When would surgery be considered for a pneumothorax?

Answer 21

If the patient has recurrent, persistent pneumothorax’s

Sometimes after first episode if serious enough

(theres another lecture with more detail on this stuff)

Question 22

What surgical procedures are carried out to treat a pneumothorax?

Answer 22

Pleurodesis

Pleurectomy

Question 23

What are bronchogenic cysts?

Answer 23

Congenital growths of tissue containing fluid or mucous

Typically occur in the mediastinum

Question 24

“Bronchogenic cysts belong to a group of cysts known collectively as __________”

Answer 24

foregut duplication cysts

Question 25

What causes the development of symptoms for bronchogenic cysts?

Answer 25

pressing on the trachea or oesophagus

Question 26

In serious cases of disease, lung transplants can be carried out

What non-cancer diseases may call for a lung transplant?

Answer 26

Cystic Fibrosis
Pulmonary fibrosis
Emphysema

Question 27

What conditions must a patient meet to be fit for a lung transplant?

Answer 27

Basically they must be otherwise healthy

Age < 65 years
Not overweight
Not diabetic
No renal failure
No mental illness
Good social support

Question 28

What is the mortality rate for a single lung transplant?

Answer 28

5-10%

Question 29

What is the mortality for a double lung transplant?

Answer 29

10-20%