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136 terms

Thoracic Surgery

Thoracic Cavity
Space between the neck and the diaphram.
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.
A triangular depression on the mediastinal surface of each lung where the bronchus, blood vessels, nerves and lymphatics enter or leave the viscus.
Most distal part of lungs. They ae microscopic air filled sacs.
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.
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.
Branches of the trachea. Enter lungs at the hilus or hilum.
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)
The medical and scientific study of cells.
Pulmonary Functions Test
Measures lung ventilation volume.
Procedure used for taking specimens for biopsy & culture and for removal of foreign bodies.
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.
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.
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.
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.
Excision of a portion of a organ or a gland. Used to treat bronchiectasis, localized inflammation, and congenital cysts or blebs.
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.
Incision into the thoracic cavity provides access to the organs in the chest.
Surgical removal of the thymus gland.
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.
A collection of pus in the space between the lung and the inside of the chest wall (pleural space).
Single Lung Transplantation - For restrictive lung disease, emphysema, pulmonary hypertension.
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.
Accumulation of blood in the pleural cavity related to trauma, inflammation or malignant neoplasm.
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.
Median Sternotomy
A midline incision into the sternum.
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.
Characterized by constriction of the bronchioles, production of excessive mucous and difficulty breathing.
Loss of volume of the lung or collapse of the lung.
Permanent dilation of the bronchi with accompanying infection. Leads to destruction of the bronchial walls.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Upper Respiratory Infection
Lower Respiratory Infection
Intrapleural air spaces that occur when the elastic fibers in the alveoli have been stretched beyond the breaking point.
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.
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
Semb or right and left Doyen
Rib Strpper/Elevator
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)
Used to bring ribs and sternum back into alignment after retraction.
Sternal Approximator
Rib Contractor
Lung Grasping
Collin-Duvall, Lovelace
Thoracic Forcep
Mixter, Harrington, Rumel, Kantrowitz, Finochietto
Artery Forcep
Schnidt, Sarot
Bone-Cutting Forcep
Scapula Retractor
Lung Retractor
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.
Cystic and pulmonary involve an abnormal proliferation of fibrous connective tissue, replacing normal tissue.
Refers to the functional cells or tissues of an organ (in this case, the lung).