Thoracic Infections and Hemoptysis Flashcards
Indications for surgery for M. tuberculosis infection
- Massive hemoptysis
- BPF
- Broncial stenosis
- Entrapped lung
- Failure of medical therapy
- Persistent cavitary diease
- Destroyed lung of lobe
- Rule out malignancy
Prior to sugery for M. tuberculosis, patients should have what profile
- Combination drug therapy for 3 months
- Sputum cultures ideally should be negative
First line medical therapy for M. tuberculosis
- INH and Rifampin (6 total months)
- INH+Rifampin+Pyrazinamide+Ethambutol (first 2 months)
Increases need for surgery for those with M. tuberculosis
Multi-drug resistant TB (MDR-TB)
Pericardial compication of TB
Pericardial effusion or constrictive pericarditis
(pericardial bx diagnostic, high level of ADA in pericardial fluid suggestive)
Tx of TB related pericardial effusion
Antibiotics
Pericardial drainage
Tx of TB related constrictive pericarditis
Antibiotics
Pericardectomy
Pleural TB associated with _
Lymphocyte-rich pleural effusion
Dx of pleural TB
Pleural biopsy (fluid culture may result in no growth)
Tx of pleural TB
- Tube thoracostomy (large effusion)
- Decortication (trapped lung or empyema)
May form in cavitary lung lesions after TB infection
Aspergillomas
Uncommon endobronchial compication that may result from TB infecton
Endobroncial stenosis (scarring) or obstruction (extrinsic compression from lymph nodes)
Tx (endobronchial stenosis): inhaled corticosteroids (I&D of lymph nodes if steroids unsuccessful, not lymph node excision)
MCC (organisms) of Non-tuberculous mycobacterial infection (NTM)
Mycobacterium avium and intracellulare (M avium complex)
Other organisms:
M. chelonae
M. abscessus
M. fortuitum
NTM infections most common in what patient populations
Disease lungs
Women
Caucasians
T/F
NTM infections more resistentant to drug therpy than MTB infecitons
True
Surgical treatment approach to NTM infections
- Pts with localized disease more amenable to surgical therapy
- Consider surgery in course of treatment
- Extrapleural dissection preferential
- d/t dense adhesions between parietal and visceral pleura
- All grossly infected tissue should be removed
- Tissue flaps used to reduce bronchial stump complications
- Continue anti-tubercular medications x 12-24 hrs postoperatively
Complications associated with surgical resections for mycobacterial infections
High rate of BPF
Overall classification scheme of lung abscesses
Primary vs. secondary lung abscess
MC overall etiology of lung abscesses
Aspiration
Atypical bacterium that classically causes multiple abscesses throughout the body, including the lungs
Actinomyces
(PCN sensitive)
Most accurate diagnostic modality for lung abscesses
High resolution CT
(cavity with air-fluid level)
First line treatment for lung abscesses
Prolonged antibiotic therapy (directed by cultures)
Lack of response to antibiotic therapy is bronchoscopy (r/o obstructive process)
Sampling of lung abscess most accurately performed by what technique
CT-guided or bronchoscopic FNA
Indications for external drainage of lung abscesses (as an adjunct to Abx)
- Failure of medical managment
- Giant abscess (>8 cm in diameter)
- Contralateral contamination
- Rupture
Indications for surgery for lung abscesses
- Empyema
- BPF
- Major hemoptysis
- Suspicion of cancer
- Failure of non-operative therapy
7 major mycotic lung infections
- Histoplasmosis
- Coccidiomycosis
- Blastomycosis
- Cryptococcus
- Mucormycosis
- Aspergillosis
- Pneumocystis