Non-lung cancer thoracic surgery Flashcards
Describe lung abscesses
Type of liquefactive necrosis of the lung tissue and the formation of cavities <2cm containing necrotic debris or fluid caused by microbial infection
What can be seen on CXR with lung abscesses?
Cavities <2cm wide with a fluid level of pus
What is the most common condition associated with lung abscesses?
Alcoholism - aspiration of vomit?
What are some common causes of abscesses?
Aspiration - anaesthesia, unconscious Pneumonia complication PTE - secondary to infarction Secondary to bronchial obstruction Septic emboli
What is one complication of lung abscesses that do not heal spontaneously?
They have to point and reach the surface in some way, can lead to empyema necessitans
What is empyema and how is it usually caused?
Presence of pus in pleural cavity, usually from the rupture of a lung abscess or from bacterial spread from pneumonia
What is empyema necessitans?
Complication of lung abscess pointing
Extension of pleural infection out of the thorax into the neighbouring chest wall and surrounding soft tissues
What are the two ways lung abscesses can point/peak?
Into pleural space (acute pain, v unwell)
Enter main airways, cough up pus
What should be suspected if a patient coughs up lots of foul smelling pus?
Anaerobic bacteria from lung abscess that has peaked into main airways
What should be suspected if there is a swelling in the groin region in TB patients?
Abscess in psoas muscle caused by lumbar tuberculosis
What is empyema thoracis?
Pus in the pleural cavity
Where is the psoas muscle?
Originates from the lumbar spine and crosses over in front of the hip bones and joins anteriorly to the head of the femur
What are the 3 stages in empyema development?
Exudative
Fibrinopurulent
Final organising stage
What are some causes of empyema thoracis?
Post pneumonic Post-op - infected blood clots Ruptured oesophagus Osteolyelitis Post trauma Boerhaave syndrome - oesophageal rupture from vomiting, vomit enters pleural cavity
What is Boerhaave syndrome?
Boerhaave syndrome - oesophageal rupture from vomiting, vomit enters pleural cavity
What is pleurectomy and decortication?
Pleurectomy - removal of pleura
Decortication - removal of masses in chest cavity
Describe the incision used in thoracotomy
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
List some thymic tumours
Thymoma Thymolipoma Thymic carcinoma - most malignant Carcinoid tumours of the thymus Lymphoma
How long is the trachea?
10-20cm
List some tracheal tumours
Salivary gland tumours (adenoid) Squamous carcinoma (smoking)
List some benign lung tumours
Hamartoma Fibroma Lipoma Neural tumours Papillomas (wart-like) Chondroma - cartilage tumour
What is the most common cause of a primary pneumothorax?
Unknown, most often seen in young tall individuals
What can cause secondary pneumothorax?
Underlying lung disease e.g. bullous disease
What causes open pneumothorax?
Trauma causing a hole in the chest bigger than tracheal diameter e.g. machete, gored by a bull
How can you immediately treat open pneumothorax before you reach hospital?
Wet cloth to cover hole with airtight seal
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
What can cause tension/closed pneumothorax?
Fractured ribs puncturing lungs
What is bullous lung disease?
Disease causing bullae (abnormal airspace) by destruction of normal lung tissue e.g. emphysema
When is surgery indicated for pneumothorax?
Recurrence
Persistence
Sometimes on first episode if patient is high risk e.g. diver, pilot
What surgical procedures are carried out for pneumothoraxes?
Pleurodesis
Pleurectomy
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
What are the top 3 causes of lung transplantation?
CF and resulting bronchiectasis
Pulmonary fibrosis
Emphysema
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
