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40 Cards in this Set
- Front
- Back
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what is the most commonly aspirated object? what is the associated risk?
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peanut. assoc risk: lipoid pneumonia
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what bronchus do foreign bodies go into more commonly?
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younger than age 4: 50/50 L/R. age 4 and older: most go into R bronchus b/c it develops into a straight shot (less of an angle)
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how can a foreign body result in air trapping and hyperinflation?
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by forming a ball valve (i.e., air in, no air out) as seen on CXR as a hyperinflated lung on expiratory film
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how can you tell on A-P CXR if a coin is in the esophagus or the trachea?
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coin in esophagus results in the coin lying "en face" w/face of the coin viewed as a round object b/c of compression by anterior and posterior structures. if coin is in trachea, it is viewed as a side projection due to the u-shaped cartilage w/membrane posteriorly
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what is the tx of tracheal or esophageal FB?
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remove FB w/RIGID bronchoscope or RIGID esophagoscope
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what is the DDx of a lung mass?
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bronchial adenoma (carcinoid most common), pulmonary sequestration, pulmonary blastoma, rhabdomyosarcoma, chondroma, hamartoma, leiomyoma, mucus gland adenoma, metastasis
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what is the DDx of a mediastinal tumor/mass?
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neurogenic tumor (ganglioneuromas, neurofibromas), teratoma, lymphoma, thymoma. (rare: pheochromocytoma, hemangioma, rhabdomyosarcoma, osteochrondroma.)
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what heart abnormality is assoc w/pectus abnormality?
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mitral valve prolapse (many patients receive preoperative echocardiogram)
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what is pectus excavatum?
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chest wall deformity w/sternum caving inward
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what is the cause of pectus excavatum?
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abnormal, unequal overgrowth of rib cartilage
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what are the signs/sx of pectus excavatum?
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often asymptomatic, mental distress, dyspnea on exertion, chest pain
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what is the tx of pectus excavatum?
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open perichondrium, removal abnormal cartilage, place substernal strut --> new cartilage grows back in the perichondrium in normal position --> remove strut 6 months later
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what is the NUSS procedure?
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for pectus excavinatum: placement of metal strut to elevate sternum WITHOUT removing cartilage
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what is pectus carinatum? what is the cause?
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chest wall deformity w/sternum outward (much less common than pectus excavatum). caused by abnormal, unequal overgrowth of rib cartilage
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what is the tx of pectus carinatum?
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open perichondrium and remove abnormal cartilage, place substernal strut, new cartilage grows into normal position, remove strut 6 months later
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what is esophageal atresia w/o tracheoesophageal fistula? what are the signs?
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blind-ending esophagus from atresia. signs: excessive oral secretions, inability to keep food down
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how is the dx of esophageal atresia w/o TE fistula made?
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inability to pass NG tube; plain x-ray shows tube coiled in upper esophagus and no gas in abdomen
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what is the primary tx for esophageal atresia w/o TE fistula? what is the definitive tx?
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primary: suction blind pouch, IVFs (gastrostomy to drain stomach if prolonged preop esophageal stretching is planned). definitive: surgical w/1ary anastomosis, often w/preoperative stretching of blind pouch (other options include colonic or jejunal interposition graft or gastric tube formation if esophageal gap is long)
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what is esophageal atresia w/tracheoesophageal fistula? what is the incidence?
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esophageal atresia occurring w/a fistula to the trachea; occurs in >90% of cases of esophageal atresia. incidence is 1 in 1500-3000 births
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define the following types of fistulas/atresias: type A, B, C, D, E
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A: esophageal atresia w/o TE fistula (8%). B: proximal esophageal atresia w/proximal TE fistula (1%). C: proximal esophageal atresia w/distal TE fistula (85%, C for Common). D: proximal esophageal atresia w/both proximal and distal TE fistulas (2%, D for Double). E: H-type TE fistula w/o esophageal atresia (4%)
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what are the sx of esophageal atresia w/TE fistula? signs?
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sx: excessive secretions caused by accumulation of saliva (may not occur w/type E). signs: obvious respiratory compromise, aspiration pneumonia, postprandial regurgitation, gastric distention as air enters the stomach directly from the trachea
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how is the diagnosis of esophageal atresia w/TE fistula made?
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failure to pass an NG tube (although not seen w/type E); plain film demonstrates tube coiled in upper esophagus; pouchogram (contrast in esophageal pouch); gas on AXR (TE fistula)
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what is the initial tx of esophageal atresia w/TE fistula? definitive tx?
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initial treatment is directed toward minimizing complications from aspiration: suction blind pouch (NPO/TPN), upright position of child, prophylactic antibiotics (amp/gent). definitive treatment is surgical correction via a thoractomy, usually through the R chest w/division of fistula and end-to-end esophageal anastomosis if possible
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what can be done to lengthen the proximal esophageal pouch in atresia w/TE fistula?
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delayed repair: w/ or w/o G-tube and daily STRETCHING of proximal pouch
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which type of esophageal atresia should be fixed via a R neck incision?
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H-type (type E) is high in the thorax and can most often be approached via right neck incision
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associated anomalies w/TE fistula
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VACTERL cluster (present in ~10% of cases): vertebral or vascular, anorectal, cardiac, TE fistula, esophageal atresia, radial limb and renal abnormalities, lumbar and limb. (previously known as VATER: vertebral, anus, TE festula, radial)
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what is the workup of a patient w/a TE fistula?
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to evaluate the TE fistula and ASSOCIATED ANOMALIES: CXR, AXR, U/S of kidneys, cardiac echo, rest of w/u directed by PE
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what is the significance of a gasless abdomen on AXR?
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no air to the stomach and thus no TE fistula
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what is a congenital diaphragmatic hernia?
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failure of complete formation of the diaphragm, leading to a defect through which abdominal organs are herniated
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what is the incidence of congenital diaphragmatic hernia?
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1/2100 live births; males more commonly affected
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what are the types of congenital diaphragmatic hernias? associated positions?
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bochdalek: posterolateral w/L>R (bochdalek - back to the left). morgagni: anterior parasternal hernia (relatively uncommon).
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what are the signs of congenital diaphragmatic hernia?
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respiratory distress, dyspnea, tachypnea, retractions, cyanosis; bowel sounds in the chest; rarely maximal heart sounds on the R; ipsilateral chest dullness to percussion
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what are the effects of congenital diaphragmatic hernia on the lungs?
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pulmonary hypoplasia, pulmonary hypertension
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what inhaled agent is often used in congenital diaphragmatic hernia?
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inhaled nitric oxide (pulm vasodilator) --> decreases shunt and decreases pulmonary hypertension
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what is the tx of congenital diaphragmatic hernia?
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NG tube, ET tube, stabilization, and if patient is stable surgical repair. if patient is unstable nitric oxide +/- ECMO then to the OR when feasible
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what is pulmonary sequestration?
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abnormal benign lung tissue w/separate blood supply that does not communicate w/the normal tracheobronchial airway
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define the following terms w/relation to pulmonary sequestration: interlobar, extralobar
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interlobar: sequestration in normal lung tissue covered by normal visceral pleura. extralobar: sequestration not in the normal lung covered by its own pleura
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what are the signs/sx of pulmonary sequestration? how is the diagnosis made?
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signs/sx: asymptomatic, recurrent pneumonia. dx: CXR, chest CT, A-gram, U/S w/doppler flow to ascertain blood supply
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what is the tx of pulmonary sequestration?
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extralobar: surgical resection. intralobar: lobectomy.
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what is the major risk during operation for pulmonary sequestration?
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anomalous blood supply from below the diaphragm (can be cut and retracted into the abdomen and result in exsanguination). always document blood supply by A-gram or U/S w/doppler flow
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