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Pulmonology and Thoracic surgery > Mediastinum, Acute infections > Flashcards

Mediastinum, Acute infections Flashcards

1
Q

Mediastinum

  • location
  • compartment
A

-behind the sternum and between the 2 lungs

  • superior - thymus, inferior trachea, carina, main bronchus, esophagus
  • inferior - anterior (internal thoracic vessels), middle (heart and pericardium), posterior (esophagus)

-another classification: anterior, visceral, paravertebral sulcus

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2
Q

Mediastinum masses

  • origin
  • most common tumors
  • location
A
  • thymus, cysts, lymphoid tissue, germ-cell tumors, neurogenic tumors
  • lymphomas, thymomas, neurogenic tumors
  • most common: anterior
  • least common - posterior
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3
Q

Mediastinum masses

  • symptoms
  • diagnosis
A

-chest pain, cough, SVC (superior vena cava syndrome), hemoptysis, dysphagia, heaviness

  • non-invasive: x-ray, US, CT + angiography, esophagogram with contrast, PET/CT
  • invasive: bronchoscopy, esophagoscopy, mediastinoscopy, thoracoscopy (VATS)
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4
Q

Mediastinum masses

-treatment

A
  • radical excision –> thoracotomy, sternotomy, mediastinoscopy, thoracoscopy
  • biopsy –> conservative
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5
Q

Thymus

-thymoma stages (Masaoka) and treatment

A

-thymoma is malignant

I - completely encapsulated –> radical surgical resection
II - trans capsular invasion –> radical surgical resection + radiotherapy
IIa - microscopic trans capsular invasion –> radical surgical resection + radiotherapy
IIb - macroscopic trans capsular invasion
III - macroscopic invasion into neighboring organ
IVa - pleural or pericardial metastasis - surgery + radiotherapy and chemotherapy
IVb - lymphagenous or hematogenous metastasis - surgery + radiotherapy and chemotherapy

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6
Q

Intrathoracic thyroid

A

-usually benign

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7
Q

Myasthenia

-pathophysiology

A
  • autoimmune Ab block acetylcholine receptors in neuromuscular synapse and reduce their numbers
  • thymus myoid cells due to their similarity to embryonic muscles cells become an antigen, which provokes the production of specific ab.
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8
Q

Myasthenia

  • symptoms
  • diagnosis
  • treatment
A
  • fatigue, general weakness
  • ocular muscles are always involved
  • deep tendon reflex is normal
  • Ab against acetylcholine receptors, X-ray, CT, MRI, electromyography
  • cholinesterase inhibitors and surgery
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9
Q

Mediastinitis

  • definition
  • etiology (5)
A
  • bacterial purulent acute inflammation of mediastinum

- odontogenic, pharyngogenic, purulent lymphadenitis, pharyngoesophageal, deep sternal infection

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10
Q

Mediastinitis

  • symptoms
  • diagnosis
  • main reasons for lethal outcomes
A
  • severe general conditions, pain, dysphagia, dyspnea, fever, sepsis
  • x-ray, CT, esophagogram, ultrasound
  • late diagnosis and insufficient opening and drainage
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11
Q

Mediastinitis

-treatment (3)

A
  • intubation
  • antibiotics
  • surgical drainage
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12
Q

Diffuse descending necrotizing mediastinitis

-diagnostic criteria - Estrera

A
  1. clinical signs
  2. radiological signs
  3. confirmation of necrotic process in the mediastinum
  4. odontogenic or pharyngogenic communication with infection in the mediastinum
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13
Q

Diffuse descending necrotizing mediastinitis

  • classification (3)
  • surgical management
A

I - superior mediastinum (till tracheal bifurcation)
IIA - spread to the anterior mediastinum
IIB - spread to the anterior and posterior mediastinum

-collar incisions, collar mediastinotomy, thoracotomy

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14
Q 
Acute infectious (non-specific) destructive pulmonary diseases 
-facilitating factors (3)
A
  • aspiration
  • microbial contamination
  • impaired immunity
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15
Q 
Acute infectious (non-specific) destructive pulmonary diseases 
-lung abscess - characteristics
A
  • infection –> ischemia –> cavity
  • localized
  • air-fluid level in the cavity
  • margins are clear
  • solitary or multiple, unilateral or bilateral
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16
Q 
Acute infectious (non-specific) destructive pulmonary diseases 
-lung abscess - treatment
A
  • broad-spectrum antibiotics - III-IV cephalosporins carbapenem
  • mucolytic, infusion, anti-inflammatory
  • if not effective in 7d. –> endobronchial catheterization, wedge resection, anatomical segmentectomy
17
Q 
Acute infectious (non-specific) destructive pulmonary diseases 
-necrotizing pneumonia - characteristics
A
  • several destructive cavities
  • margins are unclear
  • more severe, usually manifests with sepsis
  • commonly caused by S.aureus (adults), S. aeruginosa (children)
  • associated with pulmonary artery and vein thrombosis
  • secondary infection by anaerobes
18
Q 
Acute infectious (non-specific) destructive pulmonary diseases 
-necrotizing pneumonia - treatment
A
  • surgery - single stage (lung resection, pulmonectomy), multi stage (palliative –> radical)
  • antibiotics
  • chest tube if pyopneumothorax
  • radical resection after treatment acute infection
19
Q 
Acute infectious (non-specific) destructive pulmonary diseases 
-lung gangrene - characteristics and treatment
A
  • necrosis of the unit
  • margins are unclear
  • surgery
  • antibiotics
  • radical resection after treatment acute infection
  • treatment of complications: chest tube, open window thoracostomy, temporary bronchial block, thoracoplasty
20
Q 
Acute infectious (non-specific) destructive pulmonary diseases 
-diagnostics
A
  • FOUL-SMELLING SPUTUM, fever, cough, general malaise
  • x-ray - AP and lateral
  • CT
  • bronchoscopy
  • blood test
  • sputum lab test
21
Q 
Acute infectious (non-specific) destructive pulmonary diseases 
-complications (4)
A
  • pyopneumothorax
  • pleural empyema
  • ARDS
  • chest wall cellulitis
22
Q

Pyopneumothorax

-symptoms

A
  • pus and air in the pleural cavity
  • it can be total or localized
  • symptoms: sharp chest pain and dyspnea
  • problem: bronchopleural fistula and massive air leak
23
Q

Pyopneumothorax

-diagnosis and treatment

A
  • diagnosis: chest x-ray and CT –> air-fluid level

- treatment: single-stage (lung resection), multiple stage (chest tube + permanent aspiration + bronchus occlusion)

24
Q

Pleural empyema

  • definition
  • etiology (5)
A
  • pus in the pleural cavity

- parapneumonic, trauma, iatrogenic, spread from surroundings, homogeneous

25
Q

Pleural empyema

-classification

A

I - exudative
II - fibrinopurulent
III - organizational

26
Q

Pleural empyema

-diagnosis

A
  • x-ray, CT, ultrasound
  • blood, sputum, pleural fluid analysis
  • bronchoscopy
27
Q

Pleural empyema

-treatment

A
  • stage I - antibiotics, therapeutic thoracocentesis/chest tube
  • surgery –> thoracoscopic (<3w.), open thoracotomy (>3w.)

Pulmonology and Thoracic surgery (8 decks)

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