RAPID-FIRE REVIEW OF MOST COMMON CAUSES OF ENT INFECTIONS

Chapter 71 / Thoracic Surgery 621

C h a p t e r 71

Thoracic Surgery

What does VATS stand for?

Video-Assisted Thoracic Surgery

THORACIC OUTLET SYNDROME (TOS)

What is it?

Compression of the:

Subclavian artery

Subclavian vein or

Brachial plexus at the superior outlet

of the thorax

What are the causes (3)?

1. Various congenital anomalies,

including cervical rib or abnormal

fascial bands to the first rib, or

abnormal anterior scalene muscle

2. Trauma:

Fracture of clavicle or first rib

Dislocation of humeral head

Crush injuries

3. Repetitive motor injuries (baseball

pitchers)

What are the symptoms?

Paresthesias (neck, shoulder, arm, hand);

90% in ulnar nerve distribution

Weakness (neural/arterial)

Coolness of involved extremity (arterial)

Edema, venous distension, discoloration

(venous)

What are the most common

Neurologic

symptoms with TOS?

Which nerve is most often

Ulnar nerve

involved?

622 Section III / Subspecialty Surgery

What are the signs?

Paget-von Schroetter syndrome—venous

thrombosis leading to edema, arm

discoloration, and distension of the

superficial veins

Weak brachial and radial pulses in the

involved arm

Hypesthesia/anesthesia

Occasionally, atrophy in the distribution

of the ulnar nerve

Positive Adson maneuver/Tinel’s sign

Edema

What is the Adson

Evaluates for arterial compromise

maneuver?

Patient:

1. Extends neck (lifts head)

2. Takes a deep breath and holds

3. Turns head toward examined side

Physician:

Monitors radial pulse on examined side

Test finding is positive if the radial

pulse decreases or disappears

during maneuver

What is Tinel’s test?

Tapping of the supraclavicular fossa

producing paresthesias

What is the treatment?

Physical therapy (vast majority of cases)

Decompression of the thoracic outlet by

resecting the first rib and cervical rib

(if present) if physical therapy fails

and as a last resort

624 Section III / Subspecialty Surgery

What is the key diagnostic

Thoracentesis (needle drainage) with

test?

studies including cytology

What is the treatment?

1. Pigtail catheter or thoracostomy (chest

tube)

2. Treat underlying condition

3. Consider sclerosis

What is an empyema?

Infected pleural effusion; must be

drained, usually with chest tube(s)

Decortication may be necessary if the

empyema is solid

What is a decortication?

Thoracotomy and removal of an infected

fibrous rind from around the lung (think

of it as taking off a fibrous “cortex” from

the lung)

LUNG ABSCESS

What are the signs/

Fever, sputum, sepsis, fatigue

symptoms?

What are the associated

CXR: air-fluid level

diagnostic studies?

CT scan to define position and to

differentiate from an empyema

Bronchoscopy (looking for

cancer/culture)

What is the treatment?

Antibiotics and bronchoscopy for culture

and toilet, with or without surgery

What are the indications for

Underlying cancer/tumor

surgery?

Refractory to antibiotics

What are the surgical

Lobectomy of lobe with abscess

options?

Tube drainage

What is middle lobe

Recurrent right middle lobe pneumonia

syndrome?

caused most commonly by intermittent

extrinsic bronchial obstruction

HEMOPTYSIS

What is it?

Bleeding into the bronchial tree