- Dx: Patients present with fever, chest pain. Diagnose with CT chest.
- Tx: Managemnt with antibiotica, IR drainage, or surgical drainage.
- Indications for drainage:
- not responding to 8wk antibiotics
- immunocompromised or critically ill
- Indications fo surgery:
- can't exclude cancer
- bronchopleural fistula
- Operative treatment involves thoracotomy, cut down on percutaneous catheter, and placement of chest tube. Lobectomy may be required for complicatoins.
- Dx: Patients present as smokers with weight loss, cough, hemoptysis.
- Tx: Management is surgical resection and/or cisplatin, etoposide, XRT.
- Contraindications to resection include:
- T3, T4, N3
- <2cm from carina
- invading structures
- contralateral nodes or scalene nodes
- Dx: Mass is usually found on CT scan
- Tumor markers include AFP, bHCG, TSH/T4, Urine catecholamines
- Anterior mediastinum= thyroid, parathyroid, thymus, thymoma, teratoma.
- Middle mediastinum= bronchogenic cyst, pericardial cyst, lymphoma, sarcoma, granuloma.
- Posterior mediastinum= esophageal duplication cyst, lymphoma.
- Dx: Fluid analysis can differentiate causes (transudate versus exudate).
- Glucose < 3.3 and pH < 7.3 is complicated effusion / empyema, malignancy, TB, esophageal rupture, RA, or SLE (exudate).
- % Predicted postoperative FEV1 =% Preoperative FEV1 - (preoperative FEV1 × no. segments to be removed/18)
- want > 35% postoperative FEV1 for age, ht, sex.
- When the FEV1 is greater than 2 L or 50% of predicted, major complications are rare.
Special Cardiac Topics
- Recent MI
- Ideally wait 6mo after for surgery
- Bare metal stent can have surgery after 4 weeks with asa/plavix held
- Coated stent needs 1yr of asa/plavix
- Use perioperative Beta blockers.