Cardiothoracic Surgery in Non Malignant Situations Flashcards
What is a lung abscess?
Collection of pus surrounded by granulation tissue
How does a lung abscess come about?
Aspiration of foreign body
Pneumonia
PTE
Lung cancer
Septic emboli
How does pneumonia lead to lung abscess?
Infection causes necrotion of tissue developing into an abscess
The lung try’s to discharge pus and it usually bursts into the pleural space causing empyema
- Sudden onset of severe pleuritic chest pain
- Swinging fever
How can lung abscesses be treated?
Via a drain inserted into the abscess cavity to drain pus/fluid
What is an empyema throacic?
Where pus spreads throughout the pleural cavity
How can an empyema thoracic be caused?
Post pneumonic
Post operative
Oesophageal
Upper abdominal related
Osteomyelitis
Post traumatic
How can oesophageal problems cause empyema?
Vomiting with relaxation of lower oesophageal sphincter and corresponding spasm of upper oesophageal sphincter.
- Leads to rupture of the oesophagus
- Discharges vomit into pleural cavity
- Gives rise to fatal empyema
- Vomiting then chest pain!
What is the aim of a pleurectomy and decortication?
Aim is to peel off parietal and visceral pleura from the accessible portions of the chest wall and lung surface to allow the lung to expand to its normal size (never full size but 80-90%).
What is a thymoma?
Malignant tumour, type a-c
What is a thymolipoma?
Combination of a thymoma and lipoma
What is a thymic carcinoma?
Most severe type of thymic tumour
Tends to invade surrounding structures
What is the prognosis for thymic carcinomas?
Often inoperable as invade into mediastinum and structures like vena cava, heart and aorta
What are the types of thymic tumours?
Thymoma
Thymolipoma
Thymic carcinoma
Carcinoid tumours of the thymus
Lymphoma
When would you perform tracheal surgery?
Repair of iatrogenic injury
Tracheal tumours
How do iatrogenic injuries occur?
If/when anaesthetist passes endotracheal tube through wall of the trachea
What are some tracheal tumours?
Salivary gland tumours
Squamous carcinoma
What are some benign lung tumours?
Hamartoma
Fibroma
Lipoma
Neural tumours
Papillomas
Chondroma
What is hamartoma?
Proliferation of cells usually found in that organ.
So in the lung proliferation of epithelial cells, cartilage and fat.
What are neural tumours?
Associated with intercostal nerves, sympathetic trunk, vagus or phrenic nerves.
Should be removed as have pre-malignant potential (10%).
What makes a pneumothorax primary?
No underlying abnormality of the lung
Caused by a developmental defect usually only affecting a small portion of the lung, usually the apex.
What makes a pneumothorax secondary?
Widespread pathology throughout lung
Usually COPD or pulmonary fibrosis
What is the operation status of primary/secondary pneumothoraxes?
Primary = operable
Secondary = usually non-operable
Define recurrent and persistent?
Recurrent = goes away then comes back
Persistent = doesn’t go away
What is an open pneumothorax?
Physical hole in the chest wall
Air goes in via the hole not the trachea
What is the outcomes of an open pneumothroax?
Ineffective ventilation leading to quick Ventilatory failure
What is the treatment for an open pneumothroax?
Rag soaked in water to be put over the hole
Prevents air from being being sucked in
What does a pneumothorax result in?
Results in lung/lobar collapse
What is a tension pneumothorax?
Air escapes into the pleural space on inspiration but doesnt return on expiration.
Causing pressure to build up and cauing complete collapse of the lung.
What does a tension pneumothorax cause?
Mediastinal structures to shift to opposite side
What is tension pneumothorax associated with?
Flying and diving
What is the prognosis of tension pneumothorax?
Often fatal as becomes bilateral
(fatal within 10-15 minutes)
What are the treatment options for a pneumothorax?
- If bulla seen then staple it and disconnect it from the lung - stops air escaping from that section.
- Sterile talcum powder injected into pleural cavity - allows sides of pleura to stick together - pleurodesis.
What is a bulla?
A large abnormal airspace in the lung > 2cm in diameter
What happens to bulla when you fly?
They can increase in size
- Severe pain
- Pneumothorax
- Tearing of pulmonary veins
- Air can transmit from bulla to pulmonary veins to heart and end up in brain causing a stroke (cerebral air embolism).
How are bulla treated?
Via operation and removal of bulla
What are the indications for surgery in pneumothorax?
Recurrence (if had 2 or more surgery recommended).
Persistence (drain still leaking after air 7 days).
Sometimes after one episode depending on person and lifestyle.
What types of surgery are done for pneumothroax?
Pleurodesis
Pleurectomy
What are bronchogenic cysts?
Congenital lesions
Belonging to a group known as foregut duplication cysts.
What causes bronchogenic cysts?
Symptoms pressing on trachea or oesophagus
Such as:
- Stridor
- Dysphagia
- Life threatening
What is the pathology of bronchogenic cysts?
Mucous lake doesnt join with rest of bronchial tree and thus forms a duplication cyst
Where are bronchogenic cysts usually located?
Around the trachea or carina
Why would you perform a lung transplant?
Cystic fibrosis
Pulmonary fibrosis
Emphysema
What type of transplant is done in CF patients?
Double lung transplant
What type of lung transplant is done in pulmonary fibrosis patients?
Single lung transplant
- lower risk
For young people do double lung transplant
What are some conditions for getting a lung transplant?
Age < 65 years
Not overweight
Not diabetic
No renal failures
No mental illness
Good social support
What are the mortality rates for single/double lung transplants?
Single = 5-10%
Double = 10-20%
