Dear friends and colleagues, Passing the MRCP UK is an important step in the medical career. PACES is the practical clinical exam and require a wide breadth of knowledge. This blog is a space to share materials, information and knowledge and I hope you find it useful. Am open for any ideas or suggestion and would value your contributions and comments.
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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.
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
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.
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.
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?
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.
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Pay attention to the air entry during auscultation.
ReplyDeletea. 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.
thank you very much. this is 2017 and I find it very useful even today
DeleteThanks. This is really helpful
Deleteindications for lobectomy:
ReplyDelete1-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
in lobectomy:
ReplyDeletetrachea is central(unless it is upper)
apex beat dispalced.
percussion notes dull(but not stony)
breath sounds are deminished.
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.
ReplyDeleteIn 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.
ReplyDeleteHi Dear,
ReplyDeleteCan anyone please describe the scar in first picture, horizontal scar on chest with catheter in place and the sub-mammary scar. Its indication?
The scar in the first picture:
ReplyDeletetransverse thoracosternotomy, or “clamshell” incision
1st picture is Bilateral Lung Transplant
ReplyDeleteIn practice,I come across lobectomy and decortication cases with the signs as follow as well :
ReplyDeleteMid 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.
thanks alot for giving such a good piece of info but why cardiac apex displaced in lobectomy
ReplyDeleteit gives space to the heart to move aside
Deletebecause it will be pulled to wards side of surgery
ReplyDeletescar:
ReplyDelete1. 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.
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