Non-lung cancer thoracic surgery Flashcards

1
Q

Describe lung abscesses

A

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

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2
Q

What can be seen on CXR with lung abscesses?

A

Cavities <2cm wide with a fluid level of pus

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3
Q

What is the most common condition associated with lung abscesses?

A

Alcoholism - aspiration of vomit?

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4
Q

What are some common causes of abscesses?

A
Aspiration - anaesthesia, unconscious
Pneumonia complication
PTE - secondary to infarction
Secondary to bronchial obstruction 
Septic emboli
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5
Q

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

A

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

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6
Q

What is empyema and how is it usually caused?

A

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

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7
Q

What is empyema necessitans?

A

Complication of lung abscess pointing

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

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8
Q

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

A

Into pleural space (acute pain, v unwell)

Enter main airways, cough up pus

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9
Q

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

A

Anaerobic bacteria from lung abscess that has peaked into main airways

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10
Q

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

A

Abscess in psoas muscle caused by lumbar tuberculosis

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11
Q

What is empyema thoracis?

A

Pus in the pleural cavity

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12
Q

Where is the psoas muscle?

A

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

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13
Q

What are the 3 stages in empyema development?

A

Exudative
Fibrinopurulent
Final organising stage

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14
Q

What are some causes of empyema thoracis?

A
Post pneumonic
Post-op - infected blood clots
Ruptured oesophagus
Osteolyelitis
Post trauma
Boerhaave syndrome - oesophageal rupture from vomiting, vomit enters pleural cavity
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15
Q

What is Boerhaave syndrome?

A

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

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16
Q

What is pleurectomy and decortication?

A

Pleurectomy - removal of pleura

Decortication - removal of masses in chest cavity

17
Q

Describe the incision used in thoracotomy

A

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

18
Q

List some thymic tumours

A
Thymoma
Thymolipoma
Thymic carcinoma - most malignant
Carcinoid tumours of the thymus
Lymphoma
19
Q

How long is the trachea?

20
Q

List some tracheal tumours

A
Salivary gland tumours (adenoid)
Squamous carcinoma (smoking)
21
Q

List some benign lung tumours

A
Hamartoma
Fibroma
Lipoma
Neural tumours
Papillomas (wart-like)
Chondroma - cartilage tumour
22
Q

What is the most common cause of a primary pneumothorax?

A

Unknown, most often seen in young tall individuals

23
Q

What can cause secondary pneumothorax?

A

Underlying lung disease e.g. bullous disease

24
Q

What causes open pneumothorax?

A

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

25
How can you immediately treat open pneumothorax before you reach hospital?
Wet cloth to cover hole with airtight seal
26
What is a tension pneumothorax?
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
27
What can cause tension/closed pneumothorax?
Fractured ribs puncturing lungs
28
What is bullous lung disease?
Disease causing bullae (abnormal airspace) by destruction of normal lung tissue e.g. emphysema
29
When is surgery indicated for pneumothorax?
Recurrence Persistence Sometimes on first episode if patient is high risk e.g. diver, pilot
30
What surgical procedures are carried out for pneumothoraxes?
Pleurodesis | Pleurectomy
31
What are bronchogenic cysts?
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
32
What are the top 3 causes of lung transplantation?
CF and resulting bronchiectasis Pulmonary fibrosis Emphysema
33
What are the patient requirements for lung transplantation?
``` < 65yo Healthy weight (steroids) Not diabetic (steroids) No renal failure (immunosuppressants) No mental illness Good social support system ```