Introduction to thoracic surgery

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.

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.

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 cough
Of 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.

Introduction to thoracic surgery

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