Thoracic Surgery PPT #5


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Thoracic Surgery PPT #5

  1. 1. Lung Volume Reduction Surgery • Emphysematous lung compresses normal lung and depresses diaphragm. • Paradoxically can improve FEV1 and exercise function by resecting focally emphysematous lung. • Still investigational. Remove from nonfunctional lung
  2. 2. Lung Transplantation • Last resort for lung disease otherwise untreatable with death immanent. • Selection – disease, age, co- morbidity • Surgical techniques – lobe, one or both lungs • Immunosuppression • BOOP Next in line: Not for CA Better prognosis, better candidate
  3. 3. Carcinoid Tumor • Approx 1-3% % of malignant tumors of lung. • Central- smooth cherry red tumor. • Peripheral nodule • Airway obstruction and atelectasis • Typical vs. atypical Submucosal tumor; different from GI carcinoids (causes carcinoid syndrome)
  4. 4. Olser-Weber-Rendu Hemorrhagic Telangiectasia Syndrome• Familial • Nosebleeds • Lip and tongue telangiectasia on exam • Cyanosis • Cerebral abscess • Peripheral pulmonary nodules • Rx occlude feeding vessels by angio or surgery • Rare type of A-V malformation arising from a central PA In lung, skin, brain
  5. 5. Invasive Aspergillosis • Immunosuppressed pt. With prolonged neutropenia • Fever • Chest pain • Hemoptysis • Pathognomonic radiographic features • Amphotericin +/- pulmonary resection may be curative Big cavity in lungs; was thought to be TB Necrosis of lung
  6. 6. Esophageal Perforation: • Cervical or thoracic • Spontaneous- Boorhave syndrome • Iatrogenic- esophageal dilatation, intubation • Chest pain, fever • L>R pleural effusion with low pH • Dx by esophagram • Survival will depend upon surgical repair or drainage within 6-24 hours. • Very limited role for non-surgical management. Know this for test
  7. 7. Clubbing and Osteoarthropathy • Clubbing may occur with chronic cyanosis , inflammatory disease or tumor. • Hypertrophic pulmonary osteoarthropathy (HPO) occurs only with tumor. • Lung CA, fibrous tumor of pleural Pulmonary clubbing; also seen in cyanotic heart Dz Clubbing with arthralgias
  8. 8. Clubbing and HPO • Pain in knees ankles and tibia > wrists and elbows. • Pain disappears almost immediately following resection of tumor. • Clubbing resolves more slowly • Recurrence of either clubbing or HPO means that there is recurrence of tumor.
  9. 9. Pneumothorax: Very common. Spontaneous- young tall people. Apical blebs Chest tube drainage. Bleb resection and pleurodesis if recurrent. Secondary- older patients with COPD Much higher M+M Tension- lethal Increased percussion note May cause recurrence More difficult w/ underlying lung Dz.
  10. 10. Pneumothorax: • Rarely pneumothorax is caused by necrotic or cystic tumors, typically sarcomas. • In this case the pneumothorax was caused by lung metastasis from an angiosarcoma of the scalp. Lung mets that is cystic
  11. 11. Tracheal Neoplasms • Mucoepidermoid tumor • Adenocystic carcinoma • Squamous carcinoma In anterior wall of trachea Types that block the airway; in bronchi, add carcinoid May present with wheezing; DDX for asthma
  12. 12. Laser Ablation: • YAG laser ablation of endobronchial tumor offers effective palliation in Lung CA patients with dyspnea. • Mean 3 mo. • EndobrachyRT increases palliation to mean 6 mo.
  13. 13. Cardiac Herniation • If a defect is left in the pericardium more than approximately 3-4 cm in diameter, herniation of the heart may occur. • Larger defects should be repaired with 2mm PFTE • Sudden profound shock following right
  14. 14. Continuing Medical Education: • The questions that will be asked on your exam will be the same questions that will be asked twenty years from now. • BUT • The answers will change. • The bad news is that you will have to form a life-long practice of continuous self- education. • The good news is that you will still be learning new and exciting information twenty years from now.
  15. 15. Thoracic Surgery: An evolving practice • Technological change occurs with blinding rapidity. • The information and technical skills that allow one to successfully practice medicine WILL change. • Success in practice will depend upon careful evaluation of new technology with retraining as indicated.