SESAP - Thoracic

Question 1

Thoracic Duct Injury -

Presentation?

Answer 1

Chylothorax - milky white fluid. TG level > 110 –> results in severe malnutrition
Post-op from a thoracic surgery, esophageal dissection

Question 2

Thoracic Duct Injury -

Initial management?

Answer 2

NPO/TPN first. Monitor output.

Low output: < 500 mL/day
fat free diet with somatostatin analogue. (talc pleurodesis?)

High output: > 1 L/day
Despite conservative management - thoracic duct ligation v. thoracic duct embolization. embolization is successful in 60-80% patients.

Question 3

Malignant chylothorax

pathophysiology?

Answer 3

infiltration of tumor into thoracic duct and tributaries

Question 4

Malignant chylothorax

management?

Answer 4

TD ligation or embolization does NOT work. Treat the cancer.
chemotherapy followed by maybe radiation to the mediastinal LN. Surgery does not fix this.

Question 5

Percutaneous tracheostomy - technique?

contrainidications?

Answer 5

1. small anterior neck incision, dissect to anterior trachea. Seldinger technique to access and dilate then place appropriate trach.
2. Use bronchoscopy to visualize trachea.