Chapter 25 – Thoracic Flashcards
What is the path of the azygos vein?
Runs along the right side and dumps into superior vena cava
What is the path of the thoracic duct?
Runs along the right side, crosses midline and dumps into left subclavian vein at junction with IJ
Which mainstem bronchi is longer?
Left
Which pulmonary artery is longer?
Right
Which nerve runs in anterior to hilum? Which runs posterior to hilum?
Anterior – phrenic; posterior – vagus
What is the right lung volume? What is the left lung volume?
55%; 45%
What percent of the work is done by the diaphragm and quiet inspiration?
80%
What are the accessory muscles of respiration?
Sternocleidomastoid, levators, serratus posterior, scalenes
What is the function of type I pneumocyte? Type II pneumocytes?
Type I: gas exchange; type II: surfactant production
What is the purpose of pores of Kahn?
Direct air exchange between alveoli
How much pleural fluid is made in a day? Where is it cleared?
1-2 L produced by the parietal pleura, cleared by lymphatics in the visceral plural
What FEV1 is needed before surgery?
Greater than 0.8 or 40% of predicted value
What predicted DLCO is needed before surgery?
Greater than 11 to 12 mL/min/mmHg CO, at least 50% of the predictive value; represents carbon dioxide diffusion capacity
What value of pCO2 or CO2 is needed prior to resection?
pCO2 greater than 45, CO2 less than 50
Persistent air leak is most common after what operation?
Segmentectomy, wedge
Symptoms of lung cancer?
Asymptomatic with findings on routine chest x-ray, pneumonia, pain, weight loss
What is the most common cause of cancer related death in the United States?
Lung cancer
What aspect of lung cancer has the strongest influence on survival?
Nodal involvement
What is the single most common site of lung cancer metastasis?
Brain
How does recurrence present? What percent of recurrences are within the first three years?
Most commonly appears as disseminated metastases; 80%
What is the overall five-year survival rate of lung cancer? With resection?
10%; 30%
Which stages of one cancer are resectable?
Stage I and II
What is the most common lung cancer?
Adenocarcinoma
What percent of lung cancer is non-small cell carcinoma?
80%
What type of non-small cell carcinoma is associated with more peripheral lesions and distant metastases?
Adenocarcinoma
What type of non-small cell carcinoma is associated with local recurrence and more central lesions?
Squamous cell carcinoma
What percent of lung cancer is small cell carcinoma?
20%
What is the overall five-year survival rate for small cell carcinoma?
Very poor, less than 5% are candidates for surgery; 50%
What paraneoplastic syndrome is associated with squamous cell carcinoma? Small cell carcinoma? Which is most common?
Squamous cell – PTH related peptide; small cell – ACTH (most common), ADH
What is the most malignant lung tumor?
Mesothelioma
Chemotherapy used for non-small cell carcinoma stage II or higher?
Carboplatin, Taxol
What chemotherapy is used for small cell lung cancer?
Cisplatin, etoposide
What is mediastinoscopy used for?
Centrally located tumors, patients with suspicious adenopathy, ipsilateral and contralateral mediastinal nodes
What is the Chamberlain procedure?
Assesses aortopulmonary window nodes; go through left second rib cartilage
What is a Pancoast tumor?
Tumor invades apex of chest wall and patients have Horner’s syndrome or ulnar nerve symptoms
What mets to the lung may be resected if isolated and not associated with any other systemic disease?
Colon, renal cell cancer, sarcoma, melanoma, ovarian or endometrial cancer
What are the characteristics of a carcinoid tumor?
Neuroendocrine tumor, central, 50% with symptoms
What is the five-year survival of a typical carcinoid? Atypical carcinoid?
90%, 60%
What bronchial adenomas are malignant?
Adenoid cystic adenoma, mucoepidermoid adenoma, mucous gland adenoma
What is the spread of adenoid cystic adenoma?
Spread along perineural lymphatics, beyond endoluminal compartment; slow-growing, can get 10 year survival with incomplete resection
What is the most common benign adult lung tumor?
Hamartomas
What do hamartoma lesions look like on chest CT?
Have calcifications, appear as popcorn lesion
Do hamartomas require resection?
No; repeat chest CT in six months to confirm diagnosis
What is the most common mediastinal tumor in adults and children?
Neurogenic
What is the most common site for mediastinal tumor?
Anterior