Non-lung cancer thoracic surgery

Question 1

Describe lung abscesses

Answer 1

Type of liquefactive necrosis of the lung tissue and the formation of cavities <2cm containing necrotic debris or fluid caused by microbial infection

Question 2

What can be seen on CXR with lung abscesses?

Answer 2

Cavities <2cm wide with a fluid level of pus

Question 3

What is the most common condition associated with lung abscesses?

Answer 3

Alcoholism - aspiration of vomit?

Question 4

What are some common causes of abscesses?

Answer 4

Aspiration - anaesthesia, unconscious
Pneumonia complication
PTE - secondary to infarction
Secondary to bronchial obstruction 
Septic emboli

Question 5

What is one complication of lung abscesses that do not heal spontaneously?

Answer 5

They have to point and reach the surface in some way, can lead to empyema necessitans

Question 6

What is empyema and how is it usually caused?

Answer 6

Presence of pus in pleural cavity, usually from the rupture of a lung abscess or from bacterial spread from pneumonia

Question 7

What is empyema necessitans?

Answer 7

Complication of lung abscess pointing

Extension of pleural infection out of the thorax into the neighbouring chest wall and surrounding soft tissues

Question 8

What are the two ways lung abscesses can point/peak?

Answer 8

Into pleural space (acute pain, v unwell)

Enter main airways, cough up pus

Question 9

What should be suspected if a patient coughs up lots of foul smelling pus?

Answer 9

Anaerobic bacteria from lung abscess that has peaked into main airways

Question 10

What should be suspected if there is a swelling in the groin region in TB patients?

Answer 10

Abscess in psoas muscle caused by lumbar tuberculosis

Question 11

What is empyema thoracis?

Answer 11

Pus in the pleural cavity

Question 12

Where is the psoas muscle?

Answer 12

Originates from the lumbar spine and crosses over in front of the hip bones and joins anteriorly to the head of the femur

Question 13

What are the 3 stages in empyema development?

Answer 13

Exudative
Fibrinopurulent
Final organising stage

Question 14

What are some causes of empyema thoracis?

Answer 14

Post pneumonic
Post-op - infected blood clots
Ruptured oesophagus
Osteolyelitis
Post trauma
Boerhaave syndrome - oesophageal rupture from vomiting, vomit enters pleural cavity

Question 15

What is Boerhaave syndrome?

Answer 15

Boerhaave syndrome - oesophageal rupture from vomiting, vomit enters pleural cavity

Question 16

What is pleurectomy and decortication?

Answer 16

Pleurectomy - removal of pleura

Decortication - removal of masses in chest cavity

Question 17

Describe the incision used in thoracotomy

Answer 17

Patient on side
Incision on the back near 6th/7th rib and cut down chest parallel to the spine, before curving outwards to extend parallel to the ribs. Can be lower if needs to be

Question 18

List some thymic tumours

Answer 18

Thymoma
Thymolipoma
Thymic carcinoma - most malignant
Carcinoid tumours of the thymus
Lymphoma

Question 19

How long is the trachea?

Answer 19

10-20cm

Question 20

List some tracheal tumours

Answer 20

Salivary gland tumours (adenoid)
Squamous carcinoma (smoking)

Question 21

List some benign lung tumours

Answer 21

Hamartoma
Fibroma
Lipoma
Neural tumours
Papillomas (wart-like)
Chondroma - cartilage tumour

Question 22

What is the most common cause of a primary pneumothorax?

Answer 22

Unknown, most often seen in young tall individuals

Question 23

What can cause secondary pneumothorax?

Answer 23

Underlying lung disease e.g. bullous disease

Question 24

What causes open pneumothorax?

Answer 24

Trauma causing a hole in the chest bigger than tracheal diameter e.g. machete, gored by a bull

Question 25

How can you immediately treat open pneumothorax before you reach hospital?

Answer 25

Wet cloth to cover hole with airtight seal

Question 26

What is a tension pneumothorax?

Answer 26

Air escapes lung into chest cavity extremely rapidly, causing a massive increase in pressure and mediastinal shift and eventually impacting on the other lung as well. Also referred to as a closed pneumothorax

Question 27

What can cause tension/closed pneumothorax?

Answer 27

Fractured ribs puncturing lungs

Question 28

What is bullous lung disease?

Answer 28

Disease causing bullae (abnormal airspace) by destruction of normal lung tissue e.g. emphysema

Question 29

When is surgery indicated for pneumothorax?

Answer 29

Recurrence
Persistence
Sometimes on first episode if patient is high risk e.g. diver, pilot

Question 30

What surgical procedures are carried out for pneumothoraxes?

Answer 30

Pleurodesis

Pleurectomy

Question 31

What are bronchogenic cysts?

Answer 31

Present from birth, found around oesophagus and trachea and can compress these. Congenital malformations of the bronchial tree, belongs to a group of cysts known as the foregut duplication cysts

Question 32

What are the top 3 causes of lung transplantation?

Answer 32

CF and resulting bronchiectasis
Pulmonary fibrosis
Emphysema

Question 33

What are the patient requirements for lung transplantation?

Answer 33

< 65yo
Healthy weight (steroids)
Not diabetic (steroids)
No renal failure (immunosuppressants)
No mental illness
Good social support system