Station 1 - Surgical respiratory cases

Question 1

What clinical signs indicate lobectomy?

• expansion
• chest wall/skin
• trachea
• percussion/breath sounds

Answer 1

• Reduced expansion and chest wall deformity
• Thoracotomy scar
• Central trachea
• Lower lobectomy: dull percussion note over lower zone with absent breath sounds
• Upper lobectomy: may be normal, may have hyperresonant percussion note over upper zone with a dull percussion note at base due to raised hemidiaphragm.

Question 2

What investigations would you like if wondering about lobectomy?

Answer 2

• CXR: may be normal, may show raised hemidiaphragm

- CT thorax: loss of a lobe with assoc. truncation of bronchus or pulmonary vessels

Question 3

What clinical signs indicate pneumonectomy?

Answer 3

• Thoractomoy scar
• reduced expansion on side of pneumonectomy
• trachea pulled towards side of pneumonectomy
• dull percussion on side of pneumonectomy
• absent tactile vocal fremitus beneath thoracotomy scar
• Bronchial breathing in upper zone with reduced breath sounds in remainder (bronchial breathing is transmitted sound from major airways)

Question 4

What does the pnuemonectomy space fill with after the op?

Answer 4

gelatinous material

Question 5

what is seen on CXR in pneumonectomy?

Answer 5

white out

Question 6

What clinical signs are seen in a single lung transplant patient?

Answer 6

• Thoracotomy scar
• normal exam on side of scar
• may have clinical signs contralaterally

Question 7

What are the indications for single lung transplant?

Answer 7

‘dry lung’ conditions i.e. pulm fibrosis, COPD

Question 8

What clinical signs are seen in a double lung transplant patient?

Answer 8

-Clamshell incision

Question 9

What are the indiciations for double lung transplant?

Answer 9

• Wet lung conditions: CF, bronchiectasis

- pulmonary hypertension