Lung resection Flashcards
59 F with Stage 1A1 adeno CA S/p RULobectomy. 1 month post-op c/o dysnea. CXR elevated right hemidiaphragm. Dx? Next step?
Phrenic nerve injury
Diagnostic test: fluoroscopic sniff test shows paralyzed diaphragm with paradoxical motion
Management: conservative (ie observation for 1 year) at first as many will recover spontaneously. If persistent and symptomatic, consider diaphragm plication
67 M s/p LLL sleeve lobectomy, c/b pericardial effusion with hemodynamical instability with tamponade physiology. Emergent pericardiocentesis attempted but unsuccessful. Next step?
subxiphoid pericardial window. If ongoing bleeding, extend to a full sternotomy. Do NOT place an unstable patient on lateral decubitus position!!!
Hemopericardium following lung resection is rare. Mechanism includes misfired staple load or bleeding from vessel into the pericardium, or retraction of a divided pulmonary vein into the pericardial sac.
