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    Thoracic Anatomy: Lungs and Mediastinum: Dr. Carmine Simone

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    Michael Rothmans Immanuel S
    This document discusses thoracic anatomy and lung cancer. It describes the anatomy of the lungs, pleura, mediastinum, and chest x-ray findings. It then discusses the evaluation and management of solitary pulmonary nodules, including the use of CT, PET, and surgical biopsy. The principles of lung cancer diagnosis, staging, and treatment are covered, including surgery, chemotherapy, and radiation therapy. Specific staging investigations and treatments are described based on the stage of cancer.

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    Thoracic Anatomy: Lungs and Mediastinum: Dr. Carmine Simone

    Uploaded by

    Michael Rothmans Immanuel S
    24 views32 pages
    This document discusses thoracic anatomy and lung cancer. It describes the anatomy of the lungs, pleura, mediastinum, and chest x-ray findings. It then discusses the evaluation and management of solitary pulmonary nodules, including the use of CT, PET, and surgical biopsy. The principles of lung cancer diagnosis, staging, and treatment are covered, including surgery, chemotherapy, and radiation therapy. Specific staging investigations and treatments are described based on the stage of cancer.

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    anatomi

    Original Title

    Anatomy

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    This document discusses thoracic anatomy and lung cancer. It describes the anatomy of the lungs, pleura, mediastinum, and chest x-ray findings. It then discusses the evaluation and management of solitary pulmonary nodules, including the use of CT, PET, and surgical biopsy. The principles of lung cancer diagnosis, staging, and treatment are covered, including surgery, chemotherapy, and radiation therapy. Specific staging investigations and treatments are described based on the stage of cancer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    24 views32 pages

    Thoracic Anatomy: Lungs and Mediastinum: Dr. Carmine Simone

    Uploaded by

    Michael Rothmans Immanuel S
    This document discusses thoracic anatomy and lung cancer. It describes the anatomy of the lungs, pleura, mediastinum, and chest x-ray findings. It then discusses the evaluation and management of solitary pulmonary nodules, including the use of CT, PET, and surgical biopsy. The principles of lung cancer diagnosis, staging, and treatment are covered, including surgery, chemotherapy, and radiation therapy. Specific staging investigations and treatments are described based on the stage of cancer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 32

    THORACIC ANATOMY:

    Lungs and mediastinum

    Dr. Carmine Simone

    Head, Division of Critical Care


    Director, Inpatient Surgical Services
    Thoracic Surgeon

    Toronto East General Hospital


    CXR Anatomy
    Pleural and Lung Surface Anatomy

    Note that the pleura


    extends just below the
    12th rib posteriorly. This is
    important in approaching
    the kidney surgically from
    behind
    Thorax Surface Markings

    Note that the pleura


    extends just below the
    12th rib posteriorly. This is
    important in approaching
    the kidney surgically from
    behind
    Radiology - CXR

    CXR is a good initial imaging


    study

    Error rate of 20-50% for


    radiologic detection of lung
    cancer is generally accepted

    The only reliable indicators of


    benign disease in CXR are
    presence of benign
    calcifications, or the absence of
    growth over 2 years

    Doubling time for malignant


    nodules: 40-360 days
    SPN Management Algorithm
    Superior Mediastinum
    Superior mediastinum
    CT scan
    Cancer Principles
    Azygous Lobe of Right Lung
    Medial Surface of Lungs
    PET scan

    PET with 18-FDG


    a promising mode of
    tumor imaging FDG is
    taken up by cells in
    glycolysis activity in
    cells with high
    metabolic rate (tumors
    and inflammation) 96%
    sensitivity and 78%
    specificity for detecting
    malignancy
    Now available for
    evaluation of the SPN
    Surgical biopsy

    Thoracoscopy for lung


    biopsy is very reliable and
    relatively low risk
    Patient must be able to
    tolerate single lung
    ventilation
    Inflammatory lung
    diseases at risk of
    exacerbation
    Cancer Principles

    Diagnosis
    Staging
    Treatment and/or Palliation
    Staging Investigations

    CT thorax and upper abdomen


    MRI Brain vs. CT brain
    Bone scan
    Staging Investigations

    Cervical mediastinoscopy
    Cancer Principles

    Diagnosis
    Staging
    Treatment and/or Palliation
    Stage I and II

    Stage Ia Stage Ib

    Stage IIa Stage IIb


    N2 disease

    Stage IIIa

    Chemotherapy

    Radiotherapy

    Surgery
    Summary

    SPN are very common


    Always think of lung cancer as a
    diagnosis
    Tissue diagnosis versus surveillance
    Treatment and prognosis is stage
    dependent
    Case Review CT chest
    Esophageal Perforation - Thoracic
    Esophageal Perforation - Thoracic

    Technique of primary closure


    of thoracic esophageal
    perforations:
    Ipsilateral posterior
    thoracotomy
    Elevation of esophagus and
    location of esophageal
    defect
    Longitudinal incision of
    esophageal muscle to
    ensure that entire length of
    defect is visualized
    2-layer closure reinforced
    with healthy vascularized
    tissue
    Intercostal muscle,
    pericardial fat,
    pedicled diaphragm,
    omentum
    Wide debridement of
    mediastinum and
    decortication of lung
    Insertion of 3 chest tubes
    Gastrostomy and feeding
    jejunostomy
    Case #6
    Case #1
    Case #2
    Trauma Thoracotomy
    THANK YOU

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