THORACIC

Question 1

intralobar Sequestrations

Answer 1

“INTRA = venous drainage IN the lung (pulm circ)”

“INTRA = entire lobe resection”

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.

Question 2

Extra lobar sequestration

Answer 2

“EXTRA sick baby”

“EXTRA lobar venous drains OUTSIDE of lung - systmeic venous”

“EXTRA pulmonary anomalies”

VENOUS drainage is mainly via the azygos-hemiazygos SYSTEMIC (80% of cases).

IMMEDIATE symptoms infancy

has its own visceral pleura, and may even occur outside the thorax!

BOTH LEFT

BOTH artery supply systmemic

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.

Question 3

Thoracic duct course

Answer 3

aortic hiatus
travels right chest until crossed at T4/5 into left chest

drains into IJ / subclavian junction.

Question 4

Exposure of Right subclavian and innominate

Answer 4

MEDIANsternotomy

Question 5

Exposure of LEFT subclavina

Answer 5

Left thoracotomy

need supraclavicular approach for posterior left sublcavian

Question 6

what side down do you put the lung when develop bronco plural fistula

Answer 6

Put the operative site down

Question 7

traction diverticulum

Answer 7

If asymptomatic it will empty itself and just observe

Usually do not get better

PRN if asymptomatic

Question 8

Work up for esophageal leiomyoma

Answer 8

Characteristics CT scan findings are are all that you need:

Do not biopsy risk of perf since they are submucosal

Question 9

Treatment for esophageal leiomyoma

Answer 9

Double lumen ETT
Right thoracotomy
Retract the long anteriorly
incise the medialstinal pleura
Bluntly expose the esophagus

Perform longitudinal myotomy

Enucleate

Inject air in the NG tube to ensure no leak