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Notes on chest surgery lectures:
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PLEURAL DISEASES:
Thoracocentesis :-diagnostic &therapeutic method.
performed above the lower rib.(imp)to avoid neurovascular bundle.
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Chest tube "if the condition is recurrent"is closed drainage
system.(thoracostomy tube).
200-300 cc discharged I should clamp the connector ?why shouldn't drain it all
together?sudden expansion of lungscardiogenic shock & pulmonary edema,so
gradual decompression should be done.
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pleurodesis :-talc ,tetracycline,bleomycinto induce inflammationfibrosis
occlusion of area
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HYDATID CYST:
Most common site for hydatid cyst is lung then liver .
There may be combination of presence of hydatid cyst in lung &liver at same time.
If hydatid cyst was in the right lower lobe with liver involovement in hydatid
cystone incision"transdiaphragmatic " can be made to remove both concomitant
cyst.
Always when u have hydatid cyst in lung send the pt to CT scan or ultrasound of
abdomen
**Water lilly sign (very important)represent rupture of hydatid cyst .
Treatment a-medical :-albendazole
b-surgerylaparoscopy.
---Surgery types :-
1-hypertonic N.S or formaldehyde .
2-thoracotomyput pack"contain iodine" around cystremove or resection or rarely
end by lobectomy.
Sometimes we draw the fluid by the needle to reduce the pressure in the cyst
Sometimes we inject saline beyond the cyst to push it forward then we remove the
cyst.
After removal of the cyst cavity will remain :-here follow two things 1-air leak
"cyst pushes or inavade of bronchus"Treatment :-closure of the fistula
2-Bleedingtreatment :- "cauterization"
Marsuplization :-making internal surface outer surface
If u are sure no air leak is present after removal of the cyst put N.S in the field &
ask the anaesthetic to inflate.
Enucleation means complete removal of the cyst.
Excision :-removal of ectocyst & endocyst.
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Resection"lobectomy indication":
1-Multiple cysts
2-Very Large cyst
3-Destroyesd lobe of lung
LUNG CANCER
o Squamous cell carcinoma is attributed to smoking , but NOT adenocarcinoma.
Symptoms of SCC:-central symptoms :-
1-dyspnea.
2-hemoptysis
o While adenocarcioma symptoms:-
--Dullness
*TTNA:-transthoracic needle aspiration
*For staging of Lung CACT scan of abdomen .
Surgical management of Lung Ca :-
1-complete resection
2-standard surgical procedure
a-lobectomy
b-pneumonectomy
c-wedge resection
d-bilobectomy
e-segmentectomy.
**bilobectomy is done when there is :-
1-invasion
2-absent fissure in lung parenchyma "one lobe"