Mediastinum, Acute infections Flashcards
Mediastinum
- location
- compartment
-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
Mediastinum masses
- origin
- most common tumors
- location
- thymus, cysts, lymphoid tissue, germ-cell tumors, neurogenic tumors
- lymphomas, thymomas, neurogenic tumors
- most common: anterior
- least common - posterior
Mediastinum masses
- symptoms
- diagnosis
-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)
Mediastinum masses
-treatment
- radical excision –> thoracotomy, sternotomy, mediastinoscopy, thoracoscopy
- biopsy –> conservative
Thymus
-thymoma stages (Masaoka) and treatment
-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
Intrathoracic thyroid
-usually benign
Myasthenia
-pathophysiology
- 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.
Myasthenia
- symptoms
- diagnosis
- treatment
- 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
Mediastinitis
- definition
- etiology (5)
- bacterial purulent acute inflammation of mediastinum
- odontogenic, pharyngogenic, purulent lymphadenitis, pharyngoesophageal, deep sternal infection
Mediastinitis
- symptoms
- diagnosis
- main reasons for lethal outcomes
- severe general conditions, pain, dysphagia, dyspnea, fever, sepsis
- x-ray, CT, esophagogram, ultrasound
- late diagnosis and insufficient opening and drainage
Mediastinitis
-treatment (3)
- intubation
- antibiotics
- surgical drainage
Diffuse descending necrotizing mediastinitis
-diagnostic criteria - Estrera
- clinical signs
- radiological signs
- confirmation of necrotic process in the mediastinum
- odontogenic or pharyngogenic communication with infection in the mediastinum
Diffuse descending necrotizing mediastinitis
- classification (3)
- surgical management
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
Acute infectious (non-specific) destructive pulmonary diseases -facilitating factors (3)
- aspiration
- microbial contamination
- impaired immunity
Acute infectious (non-specific) destructive pulmonary diseases -lung abscess - characteristics
- infection –> ischemia –> cavity
- localized
- air-fluid level in the cavity
- margins are clear
- solitary or multiple, unilateral or bilateral
Acute infectious (non-specific) destructive pulmonary diseases -lung abscess - treatment
- broad-spectrum antibiotics - III-IV cephalosporins carbapenem
- mucolytic, infusion, anti-inflammatory
- if not effective in 7d. –> endobronchial catheterization, wedge resection, anatomical segmentectomy
Acute infectious (non-specific) destructive pulmonary diseases -necrotizing pneumonia - characteristics
- 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
Acute infectious (non-specific) destructive pulmonary diseases -necrotizing pneumonia - treatment
- surgery - single stage (lung resection, pulmonectomy), multi stage (palliative –> radical)
- antibiotics
- chest tube if pyopneumothorax
- radical resection after treatment acute infection
Acute infectious (non-specific) destructive pulmonary diseases -lung gangrene - characteristics and treatment
- 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
Acute infectious (non-specific) destructive pulmonary diseases -diagnostics
- FOUL-SMELLING SPUTUM, fever, cough, general malaise
- x-ray - AP and lateral
- CT
- bronchoscopy
- blood test
- sputum lab test
Acute infectious (non-specific) destructive pulmonary diseases -complications (4)
- pyopneumothorax
- pleural empyema
- ARDS
- chest wall cellulitis
Pyopneumothorax
-symptoms
- 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
Pyopneumothorax
-diagnosis and treatment
- diagnosis: chest x-ray and CT –> air-fluid level
- treatment: single-stage (lung resection), multiple stage (chest tube + permanent aspiration + bronchus occlusion)
Pleural empyema
- definition
- etiology (5)
- pus in the pleural cavity
- parapneumonic, trauma, iatrogenic, spread from surroundings, homogeneous
Pleural empyema
-classification
I - exudative
II - fibrinopurulent
III - organizational
Pleural empyema
-diagnosis
- x-ray, CT, ultrasound
- blood, sputum, pleural fluid analysis
- bronchoscopy
Pleural empyema
-treatment
- stage I - antibiotics, therapeutic thoracocentesis/chest tube
- surgery –> thoracoscopic (<3w.), open thoracotomy (>3w.)
