Situation
How do you manage the
following situations?
1 Previous
thoracotomy where do you open
2 Not sure what lobe
was removed 30 years ago in another country
3 Previous cardiac
surgery for CABG. How can you determine if LIMA used
4 Cardiac surgeons call you for a) nodule in lung, b) plaque on chest wall,
or c) bullae
1 Previous
thoracotomy where do you open ?
Same incision, but
open 1 space above or below to avoid adhesions to old intercostal space
adhesions.
2 Not sure what lobe
was removed 30 years ago in another country
Bronchoscopy and CT
scan will provide the answer.
3 Previous cardiac
surgery for CABG. How can you determine if LIMA used ?
Operation note
Clips on CXR in
course of mammary
CT scan may show LIMA
missing from anterior chest wall
4 Cardiac surgeons call you for a) nodule in lung, b) plaque on chest wall,
or c) bullae
a)
If easily removable wedge it out otherwise reassess
post operatively. Needle biopsy should always be possible though.
b)
Leave alone if simple plaque. If unsure biopsy.
c)
Depends on individual thoracic surgeons opinion. Small
ones are easy to tie of or staple.