Chest Wall, Lung, and Mediastinum Flashcards
Unilateral absence of costal cartilages, pectoralis muscle and breast
Poland’s syndrome
Exceedingly depressed sternum, most common chest wall deformity
Pectus excavatum
Compression of neurovascular bundle (pain and paresthesia in neck, shouler, arm, hand)
Brachial plexus compression (often ulnar n parasthesia)
Uncommonly vascular compression
Thoracic outlet syndrome
Etiology of thoracic outlet syndrome
Compression by fibromuscular bands, anterior scalene muscle, first rib or cervical ribs
Tx for thoracic outlet syndrome
PT for 3-6 months
Supraclavicular scalenectomy, brachial plexus neurolysis, or first rib resection
Tx of chest wall tumors
Wide excision
Reconstruction using autologous and/or prosthetic grafts
Etiology of spontaneous pneumothorax
Subpleural bleb
Tx of spontaneous pneumothorax
Chest tube
Stapling of blebs if recurrent or persistent air leak for 3-5 days, or hemopneumothorax
Which pleural effusion is protein-rich and which is protein-poor
Rich: exudative
Poor: transudative
Used to diagnose pleural empyema
Thoracentesis and culture
If thoracentesis fails to resolve empyema
Intercostal tube
Thoracotomy, debridement, decortication
Risk factor and location of malignant mesothelioma
Asbestos exposure, parietal pleura
Etiology of lung abscess
Aspiration
Tx for lung abscess
IV antibiotics (penicillin) 90% success
Transbronchial drainage via bronchoscopy
CT-directed catheter drainage
Surgery
Caused by repeated pulmonary infections, excessive sputum production
Bronchiectasis
Do CT, antibiotics
Popcorn-like calcification, no change for 2 yrs, well circumscribed on CT
Benign pulmonary nodule (coin lesion)
May still require biopsy
Which paraneoplastic syndromes can be caused by small cell carcinoma
ACTH, SIADH, Lambert Eaton myasthenic syndrome
Which paraneoplastic syndrome can be caused by squamous cell carcinoma of the lung
Hyperparathyroidism (PTHrP)
Horner’s syndrome, brachial plexus involvement, vertebral collapse
Pancoast tumor
Tx for bronchogenic carcinoma
Lobectomy
Extensive mediastinal lymph node involvement or surrounding tissue involvement may contraindicate
Adjuvant therapy for non small cell carcinoma
Post lobectomy chemotherapy
Adjuvant therapy for advanced local lung ca
Preoperative chemotherapy
Which lung tumor is located peripherally
Adenocarcinoma
Most others are centrally
Tx of small cell carcinoma
Chemotherapy and radiation
Which are the most common tumors with mets to the lung (4)
Colorectal
Breast
Melanoma
Renal
Diagnostic study for congenital lesions of the trachea
Air tracheography (tomography)
Bronchoscopy
Angiography
Tx of tracheal tumor
Preop antibiotics
Tracheal resection with end to end anastamosis
Elevated beta HCG, AFP and mediastinal mass
Germ cell tumor
Seminomas most common, radiosensitive and treated with resection
Others respond to chemotherapy
First thing done in workup of coin lesion
Seek old CXR
Noninvasive tests done first when lung cancer suspected
Sputum culture
CT scan
Tx small cell cancer of the lung
Chemotherapy and radiation only
How is operability of lung cancer assessed
Predicted residual function after resection
Measure FEV1, get V/Q scan for fractions and determine remainder
What is lower limit for residual pulmonary function after pneumonectomy
800mL
How is potential cure by resection assessed
Metastasis to carinal or mediastinal nodes,
Mets to other lung or liver
By CT, PET, or endobronchial ultrasound
