Non lung-cancer thoracic surgery

Question 1

What other reasons do we perform thoracic surgery for?

Answer 1

Lung Abscess
Empyema
Thymic Tumours
Tracheal surgery
Benign Lung Tumours
Pneumothorax/Bullous Lung Disease
Bronchogenic Cysts
Lung Transplant

Question 2

What are the most common causes of lung Abscess?

Answer 2

PNEUMONIA
aspiration
Pulmonary ThromboEmbolism (PTE)
Septic Emboli
Lung Cancer

Question 3

How can you see a lung abscess on a CXR?

Answer 3

visible fluid level.

Question 4

What are the common causes of empyema?

Answer 4

Pneumonia
Post-op
Oesophageal
Osteomyelitis
Post-traumatic

Question 5

How can an empyema cause a ‘trapped lung’?

Answer 5

The pus can cause an inflammatory response in the pleura leading to them thickening, this can prevent lung expansion once the pus is cleared.

Question 6

How do we treat an empyema?

Answer 6

With urgent drainage and IV antibiotics.

Question 7

How do we treat a ‘trapped’ lung following empyema?

Answer 7

Pleurectomy & Decortication.

Basicaly pealing off the pleura to allow the lung to expand again.

Question 8

What are all thymic tumours removed rapidly regardless of malignancy?

Answer 8

To prevent them spreading to sensitive areas like the aortic arch or heart itself.

Question 9

Name some types of thymic tumour:

Answer 9

Thymoma/Thymic Carcinoma
Thymolipoma
Carcinoid tumours
Lymphoma

Question 10

What kind of tracheal surgery do we do?

Answer 10

Repairing iatrogenic injury

Removing salivary gland tumours and squamous carcinoma

Question 11

What kind of benign lung tumours can arise?

Answer 11

Hamartoma
Fibroma
Lipoma
Neural Tumours
Papilloma
Chondroma (cartilaginous)

Question 12

Why is a recurrent pnemothorax often a haemopneumothorax?

Answer 12

Because adhesions from healing the first time are torn the second time leading to blood in the pleural cavity.

Question 13

What is bullous lung disease?

Answer 13

An space of trapped air growing in the lung, can fill the entire hemithorax

Question 14

What is a persistant pneumothorax?

Answer 14

One that fails to drain (i.e. the whole wont seal)

Question 15

When do we perform surgery on a pneumonthorax?

Answer 15

If its recurrent, persistant or the person needs it prevented for a special reason (e.g. military, pilot etc)

Question 16

What procedures can be done to a pneumothorax?

Answer 16

Pleurodhesis (Thoracoscopy to inspect surface of pleura, use medical staples for any tears then spray in talc to adhere the pleura)
Pleurectomy

Question 17

What are bronchogenic cysts?

Answer 17

Cysts around the main airways present from birth

They press on the trachea and oesophagus.

Question 18

What are common reasons for a lung transplant?

Answer 18

Cystic Fibrosis (need both or the affected lung will cause accelerate failure of the new)
Pulmonary Fibrosis
Emphysema

Question 19

What are contraindicators for a lung transplant?

Answer 19

>65 yrs
Overweight (as steroids post-op will cause weight gain)
Diabetic
Renal Failure
Mental Illness