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The Lung. EmbryologyBronchial systemAlveolar systemAnatomyLobesFissuresSegmentsBlood supply. DISEASES OF THE LUNG . CongenitalAgenesisHypoplasiaCystic adenomatoid malformationPulmonary sequestrationLobar emphysemaBronchogenic cyst. Infectious Lung AbscessCausesClinical FeaturesCopio
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1. THE LUNG
2. The Lung Embryology
Bronchial system
Alveolar system
Anatomy
Lobes
Fissures
Segments
Blood supply
3. DISEASES OF THE LUNG Congenital
Agenesis
Hypoplasia
Cystic adenomatoid malformation
Pulmonary sequestration
Lobar emphysema
Bronchogenic cyst
4. Infectious
Lung Abscess
Causes
Clinical Features
Copious production of foul smelling sputum
Investigation
C X R
5. Treatment
Abx
Drainage
Internal
External
Pulmonary resection
Indications
Failure of medical RX
Giant abscess ( >6cm)
Haemorrhage
Inability to R/O carcinoma
Rupture with resulting empyema
Type of Resection
Lobectomy
6. Bronchiectasis
Def
Bronchial dilatation
Cause
Congenital
Infection
Obstruction
Clinical Features
Cough
Dyspnea
Haemoptysis (50%)
Clubbing
7. Investigation
Bronchogram
CT
Bronchoscopy
Treatment
Medical
Resolve most cases
Surgical
Failure of medical Rx
Patient with localized disease
8. Tuberculosis
30,000 new cases occur annually in U.S.A
Cause
Pulmonary
Extra-pulmonary
Investigation
C X R
9. Treatment
Medical
Surgical
Failure of medical Rx
Destroyed lobe or lung
Pulmonary haemorrhage
Persistent open cavity with + ve sputum
Persistent broncho pulmonary fistula
10. Aspergillosis
Cause
Aspergillus fumigatus, A. niger
Mode of Transmission
Forms
Allergic
Saprophytic
Invasive
Saprophytic form
C-F
Aspergilloma
Chronic productive cough
Haemoptysis (patient with preexisting Disease).
11. Investigations
Skin test
Sputum
Biopsy (Invasive)
C X R
Treatment
Medical
Surgical
Indications
A significant aspergilloma
Haemoptysis
Type of resection
Segmentectomy
Lobectomy
Pneumonectomy
12. Hydatid cyst
Cause
Echinococcus granulosus
Diagnosis
Treatment
13. Tumor Benign
Malignant
Primary
Secondary
14. Primary lung carcinoma
Incidence
Risk Factor
Smoking
Others
Pathology
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Small cell carcinoma
NSCLC vs. SCLC
15. Clinical Features
Asymptomatic
Symptomatic
Lung
Surrounding structures
Rec. L. nerve
Oesophagus
C8, T1 nerve
Sympathetic
Pleure
SVC
16. distal (para-neoplastic syndrome)
PTH
ADH
ACTH
Hypertrophic pulmonary osteoathropathy
Investigations
C X R
Bronchoscopy
Trans-thoracic needle aspiration
CT Scan
MRI
Staging
(see table)
17. Management
Depends on:
Stage
Cell Type
Patient Physical fitness
NSCLC
Surgical
Radiotherapy
Chemotherapy
SCLC
Chemotherapy
Radiotherapy
18. Secondary Lung Carcinoma
Solitary Lung Nodule
Primary Carcinoma
Tuberculous Ganuloma
Mixed tumor
2 Carcinoma
Miscellaneous
Benign Vs. Malignant
Hamartoma-Carcinoid
Age
Sex
X-ray
Size
Time
Calcification
19. THE MEDIASTINUM Anatomy
Boundaries
Divisions
Traditional
Clinical
Access: Mediastenoscopy, mediastenotomy
Mediastinal mass lesions
Anterior mediatinum(5 Ts)
Middle Mediastinum(Cyst)
Posterior mediastinum(Neurogenic)
20. THYMOMA Incidence
The commonest tunmor of A.M.
Peak 40-60 y.
M : F (1 : 1)
21. Pathology
Classification
Epithelial
Lymphocystic
Lymphoepithelial
Spindle cell
Benign vs. malignant
Stages
I, II, III, IV
22. Clinical Features
Asymptomatic
Symptomatic
Mass effect
Systemic effect
M.G. is the commonest
Investigation
C X R
CT Scan
Biopsy
Bronchoscopy }
Esophagoscopy } Selected cases
Angiogram }
23. Treatment
Benign ? complete excision
Malignant ? complete excision if possibal
If non-resectable } post-op
Or } Radiotherapy
Resection incomplete }
24. Trauma RTA
Fracture Ribs Simple Complicated
Haemothorax
Pneumothorax
Flail chest
Lung Contusion and ARDS
25. Chest Wall Deformity:
Pectus excavatum
Pectus Carniatum
Infection
Chest wall tur
Thoracic outlet Syndrome.
26. Pleura Spontaneous preumothorax
Pleural effusion
Empyema
Mesothelioma .
27. Air-way: Tracheal Cougenital anomalies
Tracheal Stenosis
Tracheostomy
28. Lung Transplantation: Indication
Procedure
Outcome
29. Surgery: Thoracotomy
Thoracoscopy
Sternotomy
Analgesia