Thoracic Surgery Flashcards
What diagnostic procedure is used to visualize vascular lesions or involvement within the thorax
MRI
Which procedure diagnoses lung carcinoma and also recurrent laryngeal nerve involvement
Laryngoscopy
What can be used to remove a foreign body, remove secretions and drain infections in the lung
Bronchoscopy
Used to confirm lung/tracheobronchial tumor, source of hemoptysis, obtain lung biopsies, diagnose atelectasis or pneumonitis
Bronchoscopy
Can be used to biopsy paratracheal and subcarinal lymph nodes
Mediastinoscopy
Can be used to diagnose sarcoidosis, lymphoma and fungal infections
Mediastinoscopy
Used to detect organisms and suspected malignancies in pleural effusions
Thoracentesis
What does it mean when cytology is positive in a thoracentesis
The tumor is inoperable
Used to obtain tissue for tumor diagnosis, negative result does not rule out diagnosis
CT-directed fine needle aspiration biopsy
Necessary if needle biopsy fails, often is required
Open lung biopsy
Exposes heart, pericardium, ascending aorta and pulmonary artery
Median sternotomy
Exposes lung, esophagus, posterior mediastinum
Posterolateral thoracotomy
Used for upper lobe biopsy and sympathectomy
Axillary thoracotomy
Rapid exposure for patients with thoracic trauma
Anterolateral thoracotomy
Minimally invasive procedure that allows avoidance of a thoracotomy. Useful for effusions, diffuse lung diseases, recurrent pneumos, pulmonary nodules
Video-assisted thoracic surgery
Causes mediastinal shift away from air collection
Tension pneumothorax
Process in which air escapes the lung parenchyma into the pleural space
Tension pneumothorax
Complication of inadequately drained hemothorax
Empyema or fibrothorax
Requires thoracotomy and decortication
Tx of tension pneumothorax
Needle decompression and chest tube with underwater seal (48 hrs) and suction (24 hrs)
Tx for open pneumothorax
Cover the wound, thoracostomy tube
Tx for hemothorax
IV resuscitation and thoracostomy tube
Signs of cardiac tamponade
Hypotension and neck vein distension
Tx for cardiac tamponade
Pericardiocentesis
Median sternotomy
or left anterior thoracotomy
Tx for flail chest
Pain control (intercostal block or epidural narcotics) Aggressive pulmonary toilet possible mechanical ventilation
Persistent lung collapse after chest tube, persistent air leak, massive progressive subcutaneous emphysema
Tracheobronchial disruption
Used to diagnose tracheobronchial disruption
Bronchoscopy
Widened mediastinum, indistinct aortic knob, tracheal deviation to the right, left plural effusion
Aortic disruption
Used to diagnose aortic disruption
Aortogram
Tx of aortic disruption
Interposition graft
w/ or w/o method of distal perfusion
CXR shows evidence of stomach or colon in chest
Diaphragmatic disruption
radial tear begins at esophageal hiatus
Tx for diaphragmatic disruption
NG tube
Urgent transabdominal repair
(adhesions to lung may form within 7-10 days)
Signs of rapidly progressive mediastinitis
Esophageal disruption
requires drainage, primary closure
New onset arrhythmia, myocardial rupture, ventricular septal rupture or left ventricular failure after trauma
Cardiac contusion
Most common thoracic trauma causing edema, small airway obstruction
Pulmonary contusion
Tx for pulmonary contusion
O2, fluid restriction, pain control, chest physiotherapy and possible chest tube
Stridor, episodes of respiratory distress Dysphagia Barium shows extrinsic compression Bronchoscopy shows segmental compression Tx?
Vascular rings
Surgery divides smaller of two aortic arches
Workup of a coin lesion on CXR starts with what
Seeking old CXR
First noninvasive tests if lung cancer is suspected
Sputum cytology
CT scan
