INTRODUCTION TO THORACIC SURGERY

Professor

Abdulsalam Y Taha

School of Medicine/ University of Sulaimaniyah

Sulaimaniyah/ Region of Kurdistan/ Iraq

https://sulaimaniu.academia.edu/AbdulsalamTaha

TOPICS

Development of the lung. Developmental Anomalies. Anatomy of the lungs and the bronchial tree. Diagnostic procedures in thoracic surgery. Closed tube thoracostomy. Aspirated tracheobronchial foreign bodies. Pulmonary hydatid cysts.

DEVELOPMENT OF THE LUNG

The lung develops as a bud from the primitive foregut.

The branching of the bronchial tree is completed by the 16th week of intrauterine life.

DEVELOPMENTAL ANOMALIES

Unilateral lung agenesis.Lobar Agenesis.Congenital lobar

emphysema.Pulmonary sequestration.

CONGENITAL LOBAR EMPHYSEMA

This is a rare condition which occurs in infants,

due to a congenital absence of bronchial cartilage.

A (ball valve) mechanism occurs in the bronchus of the affected lobe,

usually the upper, which becomes increasingly distended.

The treatment is lobectomy.

ANATOMY

BRONCHOPULMONARY SEGMENTS

BRONCHOPULMONARY SEGMENT

It is the structural unit of the lung. ..Conical piece of lung parenchyma with its

base at the periphery and its tip towards the lung hilum.

Each segment has its own segmental bronchus and artery.

The inter-segmental veins run in the inter-segmental plane and drain adjacent segments.

DIAGNOSTIC PROCEDURES

Chest radiography. Computed tomography. Sputum cytology. Bronchoscopy. Bronchography. Pulmonary function tests.

BRONCHOSCOPY

It is the endoscopic visualization of the bronchial tree.

Types: rigid and flexible. Indications: diagnostic and therapeutic. Therapeutic: removal of foreign bodies,

removal of retained chest secretions and stent placement.

DIAGNOSTIC BRONCHOSCOPY

Unresolved cough. Haemoptysis. Stridor. Hoarseness of voice. Suspected lung tumours. Infective process: Bronchiectasis, Lung abscess,

pulmonary tuberculosis. Abnormal chest radiograph. Positive sputum cytology with normal chest

radiograph.

BRONCHOSCOPIC PICTURES

PULMONARY FUNCTION TESTS

Spirometry: measurement of lung volumes like: vital capacity and forced expirotory volume (FEV1).

Arterial blood gas analysis: P O2, P CO2 and Ph.

Perfusion and ventilation lung scans. Pulmonary angiography.

CLOSED TUBE THORACOSTOMY

The chest tube is a tube drain of the pleural space.

The pleural space is a potential space. The intra-pleural pressure is negative i.e,

sub-atmospheric; important to keep the lung expanded.

Procedure, complications, removal.

INDICATIONS

Abnormal collection of fluid and/ or air in the pleural space (air: pneumothorax,

serous fluid: hydrothorax, blood: haemothorax,

blood and air: haemopneumothorax, fluid and air: hydropneumothorax,

pus: empyaema or pyothorax, pus and air: pyopneumothorax,

lymph: chylothorax).

ASPIRATED TRACHEOBRONCHIAL FOREIGN BODIES

This is a common condition especially in children 1 to 5 yrs old.

The usual cause is family negligence. Children may inhale varieties of foreign bodies: vegetable and non-vegetable. Vegetable FB like watermelon seed, sunflower seed

and peanuts induce a severe inflammatory reaction beside their mechanical effects.

Metallic FB also occurs like safety pins. Crying and laughing while eating is the usual

mechanism.

DIAGNOSIS

History: the accident may have been witnessed by a family member or not.

Choking while eating or playing is common. Sudden onset of dyspnea in a previously healthy child. Cyanotic attack. Persistent cough. Strider (a harsh inspiratory sound produced by an

upper airway obstruction may indicate a FB in central airway like larynx or trachea.

Unilateral wheeze. Fever occurs when there is a superadded infection.

DIAGNOSIS…

Examination: signs of respiratory distress may be present. CXR may be normal if the FB is not radio- opaque. or it can show a radio- opaque FB such as bone. Obstructive emphysema: is produced by intra-bronchial

FB that allows air to enter in inspiration and prevents its exit in expiration.

Lung collapse (complete or partial) is produced by a FB that blocks the bronchus completely.

Unresolved pneumonic consolidation. Lung abscess or broncheictasis are caused by a long-

standing FB.

A five and a half yr old boy: non-resolved coughOf 40 days duration

TREATMENT

Removal of the FB using rigid bronchoscopy under GA.

Sometimes surgery is needed

(thoracotomy and bronchotomy) for impacted FB which fails to be removed by bronchoscopy.

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