Wednesday, 28 May 2008

scar in respiratory station



what is the scar indicate in both patients?
(not every scar is lobectomy/pneumonectomy,..is it)



examin this patient chest.
describe your findings.
what is the most likely diagnosis?

Lobectomy Vs pneumonectomy
what is the indication in each.

45 comments:

  1. Pay attention to the air entry during auscultation.
    a. If air entry is reduced, then think of lobectomy and pneumonectomy.
    b. If air entry is equal, then think of decortication and bullectomy.

    Lobectomy Vs pneumonectomy.
    The similarities:
    1. Both have thoracotomy scars.
    2. Both have reduced chest expansion and reduced AE.

    The differences:
    1. The signs of lobectomy are confined to lobe which is removed. The signs are similar to pleural effusion except it is not stony dull.

    2. The signs of pneumonectomy are extensive i.e. involve the whole lung. The side involved would be flatten. It is similar to whole lung collapse.

    3. Normally, the tracheal is central in lobectomy except for upper lobe. The tracheal is almost always shifted in pneumonectomy.

    ReplyDelete
  2. indications for lobectomy:
    1-lung cancer:
    25% of non-small cell lung cancer will be suitable for attempted surgical resection.
    2-solitary pulmonary nodule of uncertain cause
    3-localized bronchiectasis
    4-TB was previously treated surgically

    ReplyDelete
  3. in lobectomy:
    trachea is central(unless it is upper)
    apex beat dispalced.
    percussion notes dull(but not stony)
    breath sounds are deminished.

    ReplyDelete
  4. Indications for pneumonectomy are the same as those for lobectomy. Usually the disease process is more advanced or severe however, as pneumonectomy means removal of one whole lung.

    ReplyDelete
  5. In lobectomy signs are SUBTLE (may be normal due to compensatory hyperexpansion of the remaining lobes), In pneumonectomy signs are MARKED (diaphragm moves up, mediastinum shifts toward pneumonectomy side and the area gets filled with the fluid therefore complete white out on CXR.

    ReplyDelete
  6. Hi Dear,
    Can anyone please describe the scar in first picture, horizontal scar on chest with catheter in place and the sub-mammary scar. Its indication?

    ReplyDelete
  7. The scar in the first picture:
    transverse thoracosternotomy, or “clamshell” incision

    ReplyDelete
  8. 1st picture is Bilateral Lung Transplant

    ReplyDelete
  9. In practice,I come across lobectomy and decortication cases with the signs as follow as well :

    Mid line TRACHEA ,THORACOTOMY SCAR , resonant note over operated side and NORMAL AIR ENTRY ( normal breath sound ).

    Although traditional signs being localized dullness and reduced air entry over operated side in such cases.

    ReplyDelete
  10. thanks alot for giving such a good piece of info but why cardiac apex displaced in lobectomy

    ReplyDelete
    Replies
    1. it gives space to the heart to move aside

      Delete
  11. because it will be pulled to wards side of surgery

    ReplyDelete
  12. scar:
    1. first one with tunneled central line- "clamshell incision" for lung translplant.
    2. bilateral thoracotomy- also for lung transplant or wedge resection
    3. left throacotmy/ thoracoabdominal- lobectomy, pneumonecotmy, oesophageal surgery.

    i am thoracic surgeon, i have done this preocedre.

    ReplyDelete
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