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Thoracic Cavity

Space between the neck and the diaphram.

Lungs

A pair of light, spongy organs in the thorax, constituting the main component of the respiratory system.

Right Lung Lobes

3 Lobes (Is larger, heavier and shorter).

Left Lung Lobes

2 Lobes (Upper lobe has an indentaton for the heart, "Cardiac Notch").

Lung Segments

Small subdivisions.

Hilum

A triangular depression on the mediastinal surface of each lung where the bronchus, blood vessels, nerves and lymphatics enter or leave the viscus.

Alveoli

Most distal part of lungs. They ae microscopic air filled sacs.

Pleura

Serous membrane surrounding the lungs.

Parietal Pleura

Lines the chest wall, covers the diaphram and reflects over mediastinal structures.

Visceral Pleura

Covers the lung exterior, filling fissures between lobes.

Diaphragm

Dome shaped muscle separating the thoracic area from the abdominal cavity; primary muscle to help with breathing.

External Intercostals

Secondary muscle for inhalation.

Internal Intercostals

Secondary muscle for expiration.

Bronchi

Branches of the trachea. Enter lungs at the hilus or hilum.

Bronchiole

Small branch of a bronchus.

Chest X-Ray

Posteroanterior (PA) and lateral projections indicate lung and heart configuration.

Sputum Culture Analysis

Material coughed up from the lungs and expectorated (spit out) through the mouth to find & identify the microorganisms causing infection of the lower respiratory tract. (Sent to Pathology)

Cytology

The medical and scientific study of cells.

Pulmonary Functions Test

Measures lung ventilation volume.

Bronchoscopy

Procedure used for taking specimens for biopsy & culture and for removal of foreign bodies.

Thoracoscopy

Procedure to visually examine the pleura, lungs, and mediastinum and to obtain tissue for testing purposes. Generally used to diagnose carcinoma of the lung and pulmonary infections.

Tuberculin Skin Test

Used to verify presence of particular active or dormant bacteria based on a positive reaction.

Transthoracic Needle Biopsy of the Lung

Biopsy taken to aid in the diagnosis of pulmonary infections or carcinoma of the lung.

Scalene/Supraclavicular Lymph Node Biopsy

Biopsy to diagnose bronchial carcinomas or esophageal cancer.

Decortication of the Lung (Pleurectomy)

Removal of any fibrous deposit or restrictive membrane on the visceral and parietal pleura interfering with respiratory function.
Procedure will produce copious surface bleeding.

Flexible Bronchoscopy

Procedure used to treat atelectasis, lung abscesses, and strictures.

Lobectomy

Typically performed to remove metastatic lesions, large centrally located lesions, for bronchiectasis, blebs or bullae from emphysema, and fungal infections.

Lung Biopsy (wedge resection)

Used to remove small, peripherally located benign primary tumors, or for localized inflammatory disease, and to aid in diagnosis of chronic diffuse lung disease.

Mediastinoscopy

Procedure used to examine the organs in the area between the lungs and nearby lymph nodes. Useful in the diagnosis of nodes involved in lymphomas and granulomatous conditions.

Pericardectomy/Pericardial Window

A surgical cardiac procedure that removes all or part of the pericardium. Performed for patients with thickened fibrotic pericardium.

Pnuemonectomy

Removal of an entire lung, usually for malignant neoplasms.

Repair of Pectus Excavatum/Carinatum

Correction of deformities of the sternum and/or costal cartilage of the anterior chest wall.

Rigid Bronchoscopy

Most often performed to remove foreign body aspiration, especially from the airways of infants and children.

Segmentectomy

Excision of a portion of a organ or a gland. Used to treat bronchiectasis, localized inflammation, and congenital cysts or blebs.

Thoracoplasty

Surgical removal of ribs to gain access during surgery or to collapse the chest wall and a diseased lung. (Repairative or plastic surgery performed on the thorax). Used primarily in the treatment of chronic thoracic empyema.

VATS - Video Assisted Thoracic Surgery, Thoracoscopy

Most commonly used to diagnose intrathoracic disease, but also used to evaluate pericardial disease or trauma. A technique used in the aid of placement of chest tubes.

Thoracostomy Closed (Insertion of a chest tube)

Allows continuous aspiration of air, blood or infectious fluid from the pleural cavity.

Thoracotomy

Incision into the thoracic cavity provides access to the organs in the chest.

Thymectomy

Surgical removal of the thymus gland.

Esophagectomy

Excision of all or part of the esophagus.

Lung Transplantation

Involves the removal of one or both diseased lungs and the replacement. LEVEL III SURGERY - for patients suffering from COPD, cystic fibrosis or end-stage pulmonary fibrosis.

Tracheal Bifurcation

The division of the trachea into the right and left bronchi; The Fork In The Road!

Lung Biopsy

Resection of a small portion of the lung for diagnosis.

Lung Volume Reduction Surgery

Treatment for severe pulmonary emphysema. Remove 20%-30% of each lung.

Empyema

A collection of pus in the space between the lung and the inside of the chest wall (pleural space).

SLT

Single Lung Transplantation - For restrictive lung disease, emphysema, pulmonary hypertension.

DLT- CF

Double Lung Transplantation - Cystic Fibrosis
For end stage lung failure.

Cervical Rib Resection

Performed for thoracic outlet syndrome. Usually at the livel of the 1st rib. Decompression accomplished via partial or entire removal of the rib.

Thoracic Outlet Syndrome

A condition due to compromise of blood vessels or nerve fibers between the armpit (axilla) and base of the neck, usually due to compression.

Hemothorax

Accumulation of blood in the pleural cavity related to trauma, inflammation or malignant neoplasm.

Pneumothorax

Accumulation of air or gas in the pleural cavity resulting in the collapse of the lung on the affected side.

Chest Tube & Drainage Systems

A catheter inserted through the rib space of the thorax into the pleural space to remove air and/or fluid, thereby restoring negative pressure in the pleural space. It is attached to a water sealed chest drainage device. *It is commonly used after chest surgery and lung collapse.

Pleural Effusion

Abnormal accumulation of fluid within the intrapleural space of the lungs.

Pectus Carinatum

An abnormality of the chest in which the sternum (breastbone) is pushed outward. (AKA: Pigeon Breast) Congenital

Pectus Excavatum

A funnel shaped depression of the lower end of the sternum.
Congenital

Median Sternotomy

A midline incision into the sternum.

Adenocarcinoma

Carcinoma derived from glandular tissue or in which the tumor cells form recognizable glandular structures. *The most common malignant tumor in both men and women.

Asthma

Characterized by constriction of the bronchioles, production of excessive mucous and difficulty breathing.

Atelectasis

Loss of volume of the lung or collapse of the lung.

Bronchiectasis

Permanent dilation of the bronchi with accompanying infection. Leads to destruction of the bronchial walls.

Bronchitis

Inflammation and swelling of the bronchi. *Can be chronic or acute.

Chronic Obstructive Pulmonary Disease (COPD)

Irreversible condition that results in diminished capacity of the lungs.

Emphysema

Chronic respiratory disease characterized by permanent enlargement of the alveoli and alveolar ducts of the lungs.

Laryngeal Edema

Fluid accumulation around the vocal chords, resulting from an infection, injury or inhalation of toxic gas.

Laryngitis

Upper Respiratory Infection characterized by edema of the vocal chords.

Lung Abscess

Necrosis of the pulmonary tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection.

Pnuemonia

Inflammation of the lung, usually caused by an infection. Three common causes are bacteria, viruses and fungi. Can also acquire pneumonia by inhaling a liquid or chemical.

Pulmonary Edema

An abnormal build up of fluid in the air sacs of the lungs, which leads to shortness of breath. It is usually caused by heart failure.

Respiratory Distress Syndrome, infant or adult (IRDS or ARDS)

Absence, impairment or removal of surfactant lining the alveoli of the lungs. Respiratory failure is immanent if not corrected.

Rhinitis

Inflammation of the mucous membrane of the nose.

Small Cell Lung Cancers or Oat Cell Carcinoma

Cells resemble oat grains under a microscope. Usually originates in the large, central bronchi . Spreads quickly! Prognosis not good due to lack of signs and symptoms until it is to late. Usually caused by smoking!

Squamous Cell Carcinomas

Begins in squamous cells -- thin, flat cells that look like fish scales under the microscope. Found in the tissue that forms the surface of the skin, the lining of hollow organs of the body, and the passages of the respiratory and digestive tracts.
Constitute 20-35% of all carcinomas.

Turberculosis

A contagious bacterial infection (Mycobacterium) that mainly involves the lungs, but may spread to other organs. *An invasive, debilitating infection caused by the acid-fast organism.

Undifferentiated Large Cell Carcinomas

Aggressive tumors distinguished by absence of squamous or glandular differentiation by light microscopy and exibiting large tumor cells arranged in monotonous fields with moderate cytomplasm coarse peripherally clumped chromatin and prominent nuclei.

Lung Scans, Perfusion, or Ventilation

Involves two nuclear scan tests. These test are inhaled and injected radioactive material (radioisotopes) to measure breathing (ventilation) and circulation (perfussion) in all areas of the lungs. *Used in identifying COPD

Needle Biopsy of the Parietal Pleura

An aspiration needle biopsy of the parietal pleura.

Pharyngitis

Sore throat; inflammation of the pharynx.

Hiatal Hernia Repair

Surgery to repair a bulging of stomach tissue through the muscle between the abdomen and chest (diaphram) into the chest.

Double Lumen Endotracheal Tube

Allows anesthesia to ventilate non-operative lung and to collapse operative lung, aiding surgeon's vision.

Traditional Endotracheal Tube

Single Lumen tube used for intubation once thoracic procedure is completed.

Pnuemo

Lung!

Trachea

Formed by 16-20 C-shaped rings of hyaline cartilage with a strong layer of transverse smooth muscle within the dorsal wall and lined with mucous membrane.

Right Bronchus

Shorter and more vertical.

Left Bronchus

Longer and more horizontal.

Bony Thorax

Conical, protective portion of the axial skeleton that houses the organs of the chest.

Sternum

Consists of three portions: Upper manubrium, Central gladiolus, Lower xiphoid cartilage.

True Ribs

The first 7 seven pair.

False Ribs

The 8th, 9th and 10th pair articulate with their respective costal cartilage.

Floating Ribs

The 11th and 12th pair are free floating.

Intercostal Spaces

Spaces between ribs are wider in the anterior and narrower in the posterior.

Respiration

Two phases: Inspiration & Exhalation

Inspiration Phase

The period when air flows into the lungs.

Expiration Phase

The period when gases leave the lungs.

Pleural Space

Space filled with a lubricating fluid between two pleura and the ribs.

Pleural Fluid

Secreted by the serous membrane. Provides lubrication to help enable breathing.

URI

Upper Respiratory Infection

LRI

Lower Respiratory Infection

Blebs

Intrapleural air spaces that occur when the elastic fibers in the alveoli have been stretched beyond the breaking point.

Bullae

Emphysematous air spaces covered by a thin membrane made of visceral pleura and connective tissue as well as fine blood vessels. They must be larger than 1cm in diameter.

Pulmonary Functions Tests

Various tests measure lung ventilation volume.

Hypoxia

Insufficient amounts of oxygen in blood or tissue.

Endotracheal Tube

A flexible plasitic tube inserted through the mouth and down into the trachea (airway). Used to ventilate the lungs.

Endobronchial Tube

A single or double lumen tube with an inflatable cuff at the distal end that, after being passed through the larynx and trachea, is positioned so that ventilation is restricted to one lung.

Laryngeal Mask Airway (LMA)

Preferred for flexible fiberoptic bronchoscopy performed under general anesthesia or topical anesthesia for critically ill patients.

Ventilator or Intermittent Positive Pressure Breathing Machine (IPPB)

Improves patient ventilation; used most commonly for rigid bronchoscopy in anesthetized and paralyzed patients.

Tetracycline & Doxycycline

Antibiotic agents instilled in thoracic cavity for patients with recurring pleural effusion.

Anti - Neoplastics

Instilled to promote post-surgical fibrosis: Bleomycin Sulfate (Blenoxane), Fluorouracil, Thiotepa or Uracil Mustard.

Elevators and Raspatories

Cutting and dissecting instruments used to free, cut, strip periosteum from the bone or smooth bone surfaces.

Periosteal Elevators

Langenbeck, Overholt, Sedillot

Costal Peristeotome

Alexander-Farabeuf

Raspatory

Semb or right and left Doyen

Rib Strpper/Elevator

Matson

Rib shears

Cutting instruments used to remove a rib or rib segment. (Bethune, Gierty, Gluck, Shoemaker, Sauerbauch)

Sternal Knife/Chisel

Cutting instrument used to transect or remove sternal segment. (Lebsche)

Sternal Saw

Cutting instrument used to transect the sternum.

Bronchus Clamps

Used to clamp bronchus. (Lee, Sarot)

Contractor/Approximators

Used to bring ribs and sternum back into alignment after retraction.

Lemmon

Sternal Approximator

Bailey

Rib Contractor

Lung Grasping

Collin-Duvall, Lovelace

Thoracic Forcep

Mixter, Harrington, Rumel, Kantrowitz, Finochietto

Artery Forcep

Schnidt, Sarot

Bone-Cutting Forcep

Stille-Liston

Scapula Retractor

Davidson

Lung Retractor

Allison

Sternal Retractor

Cooley, Morse

Rib Spreader

Exposing instrument used to spread thoracic cavity bones and tissues. (Burford-Finochietto, Finochietto, Tuffier)

Hemoclips Appliers with Loads

Used for maintaining hemostasis.

Relevant Positions for Thoracic Surgery

Lateral, Supine, Modified Supine (Dorsal Recumbent)

Posterolateral Thoracotomy Incision

Made over the rib or intercostal space and may or may not involve rib resection.

Anterolateral Thoracotomy Incision

Inframammary incision over the 2nd or 3rd interspace from the anterior midline or sternal border to midaxillary line.

Alternative Thoracotomy Incisions

Axillary or Transaxillary

Median Sternotomy Incision

Made over the length of the sternum from gladiolus to xiphoid process, used for mediastinal surgery such as thymectomy. *Requires transection of the sternum with powered saw.

Thoracoabdominal Incision

Extends from axilla to abdominal midline, running parallel to the selected intercostal space (commonly 6th, 7th, or 8th) and may extend to the posterior axillary line from within the thoracic cavity.

Fibrosis

Cystic and pulmonary involve an abnormal proliferation of fibrous connective tissue, replacing normal tissue.

Parenchyma

Refers to the functional cells or tissues of an organ (in this case, the lung).

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