THORACIC Flashcards
abscesses are more common on what side
right and present with an air-fluid level on imaging.
surgical indications to treat lung abscess include
if medical management does not clear the infection after 8 weeks,
large cavities over 4-6 cm,
hemoptysis,
ruling out malignancy.
Solitary pulmonary nodules
algorithm for any size:
If there is evidence that the nodule has been stable for over 2 years, then a follow up x-ray can be repeated in 1 year
If there is any change in character or size:
CT scan
Nodules that appear benign with smooth borders and a size less than 5mm:
may be followed with serial x-rays
The presence of calcification suggests:
benign nodule and a follow up chest x-ray is all that is indicated
If the doubling time is between one month and one year:
increased likelihood of malignancy
If the doubling time is over one year:
more likely benign.
patients who are over the age of 50:
50% chance of having some malignancy associated with the nodule
Superior Vena Cava (SVC) syndrome
most commonly due to
The diagnosis is often made by
treatment
most commonly due to an obstructing tumor that originates in the lung
The diagnosis is often made by
CT scan
bronchoscopy or needle biopsy may also be beneficial
The treatment for SVC syndrome is
CHEMO and RADIAITON!
Surgery is rarely possible due to the involvement of the major blood vessels.
Sequestrations represent malformations of the
lung in which there is usually no bronchial communication.
intralobar Sequestrations
reside within the lung parenchyma,
NOT asso with anomalies
BOTH systemic ARTERY supply
BOTH LEFT
intralobar medial or posterior segments of the lower lobes,
systemic artery arising from the infradiaphragmatic aorta and located within the inferior pulmonary ligament
venous drainage PULMONARY circ ( inferior pulmonary vein) but may also occur by way of systemic veins.
Because of the risk for infection and bleeding, intralobar sequestrations are usually removed, either by segmentectomy or lobectomy (NOT wedge)
More recently, CT and MRI have replaced the need for angiography and provide excellent mapping of the blood supply.
extralobar Sequestrations
IMMEDIATE symptoms infancy
has its own visceral pleura, and may even occur outside the thorax!
BOTH LEFT
BOTH artery supply systmemic
EXTRA lobar drains OUTSIDE of lung - systmeic venous
VENOUS drainage is mainly via the azygos-hemiazygos SYSTEMIC (80% of cases).
3 times more on left
ANOMOLIES in roughly 40% of cases - these are funky and can be entirely out of the chest
ASSO: posterolateral diaphragmatic hernia, eventration of the diaphragm, pectus excavatum and carinatum, enteric duplication cysts, and congenital heart disease.
normal aortic valves, the valve area
3.0 to 4.0 cm2.
percent narrowing of aortic valve needed to see clinical difference
orifice area falls by more than 50 percent.
Aortic stenosis should be treated with
valve replacement on an elective basis once symptoms of angina or syncope occur.
if present with symptoms of congestive heart failure:
emergent valve replacement.
Asymptomatic patients with a valve area less than or equal to 1.0 cm2:
surgical valve replacement
in children:
Balloon valvuloplasty has some effectiveness
NOT treatment of adults with aortic valve disease.
Bottom Line: Any symptoms related to aortic stenosis requires a replacement of the aortic valve.
Define severe aortic stenosis
1, 4, 40
valve area 4.0 m/sec
and/or
mean transvalvular gradient >40 mmHg
The thoracic duct course
the main lymphatic channel for the abdomen and chest.
Chylomicrons and long-chained fatty acids enter into this lymphatic system, whereas short and medium-chained fatty acids are transported in the portal system.
It originates at the cysterna chyli at L1-L2 and courses superiorly through the aortic hiatus. It runs along right of midline until crossing to the left at T4-T5. The duct then empties in to the left subclavian vein at the junction with the internal jugular vein.
Bottom Line: The thoracic duct crosses midline at T4-T5 and empties into the left subclavian vein.
small cell and squamous cel parneoplastic syndromes
Small cell
ADH
ACTH.
Squamous cell
PTH-related peptide
