thoracic surgery

Thoracic Surgery

Introduction to

Embryology:

Anatomy:

Mechanism of breathing

• Spirometry

• ppo FEV1
• DLCO
• VO2 max
• V/P scan


Bronchoscopy:
• Hemoptysis
• Chronic cough
• Localized wheeze
• Pulmonary mass on chest X-ray
• Recurrent or unresolved pneumonia
• Preoperative resectability assessment
• Suspicion of malignancy;
• Indications:

Indications (cont.):

Therapeutic:
• Foreign body inhalation
• Difficult intubation
• Atelectasis
• Stricture dilatation
• Lung abscess drainage
• Laser therapy
• Cryotherapy
• Brachytherapy


Flexible Bronchoscopes:
• Better patient tolerance
• Topical anesthesia
• Wider field of view
• Flexibility
• Ambulatory setting
• Useful in patients with cervical spine disorders.
• Allows assessing movement of vocal cords.
• Advantages:

Disadvantages:

• Small instrument channel size
• Difficulties in sterilization and maintenance
• Impinges on the airway
• Needs patient cooperation
•




Rigid Bronchocopes:
• Durability
• Large instrument channels
• Control of airway
• Advantages:

Disadvantages:

• Needs general anesthesia
• Limited distal visualization
• Higher cost
• Higher risk of trauma
• Contraindications:
• Thoracic aortic aneurysm
• Cervical spine disorders

Complication of bronchoscopy

• Laryngospasm and / or bronchospasm
• Hypoxemia
• Tracheal or bronchial obstruction
• Tracheal or bronchial perforation
• Bleeding
• Arrhythmias and cardiac arrest
• Pneumonia
• Air embolism
• Pneumothorax


Pulmonary Hydatid Disease:
Cyst full of water
Echinococcus granulosus

Pathology:

• Adventicia

• (host tissue)
• Ectocyst
• (Laminated membrane)
• Endocyst
• (germinal layer)
• Broad capsule

Clinical presentation:

• Asymptomatic
• Rupture →cough, hemoptysis, watery sputum
• Coughing up "grape skin"
• 2ry infection →fever, rigor, purulent sputum
• Hydropneumothorax or pyopneumothorax
• Anaphylaxis


Investigations:
1. CXR 2. CT scan
1) well defined circular or oval homogenous opacity

2) perivesicular pneumocyst or signet ring sign

3) An empty cavity

4) Bilateral and multiple cysts

5) Hydro- or pyo-pneumothorax

Treatment:

Surgical treatment:
• Removal of the cyst
• Aspiration / evacuation technique
• Enucleation technique
• Excision
• Anatomical resection:
• Segmentectomy
• Lobectomy
• Pneumonectomy
Medical treatment:
• not effective

Bronchiectasis:

Causes:

• Congenital

• Acquired
•

Clinical presentaion:

• A persistent productive cough of purulent sputum, with fetor oris.
• Hemoptysis
• Recurrent pneumonitis
• On examination:
• Cyanosis,
• Clubbing
• Coarse crepitations.

Investigations:

• CXR
• CT scan
• Bronchography

Treatment:

Medical treatment:
• Prevent infection
• Physiotherapy and postural drainage

Surgical treatment indicated in:

• Localized bronchiectasis
• Massive hemoptysis
• Recurrent suppurition
• Anatomical resection

Lung Abscess:

• Primary necrotizing pneumonia
• Aspiration pneumonia
• Bronchial obstruction
• Systemic sepsis
• Pulmonary trauma
• Direct extension
• Causes:


Diagnosis:
Fever, poor appetite, malaise, dyspnea, copious purulent sputum, hemoptysis
CXR
CT scan
Sputum culture
Bronchoscope

Treatment:

Medical treatment:
Prolonged antimicrobial therapy
Drainage

Surgical treatment:

No response
Suspicion of malignancy
Significant hemoptysis
Complications of lung abscess

Thank You