TB Surgical indications in pulmonary TB: 1. Diagnosis (wedge excision of solitary peripheral nodule [tuberculoma]) 2.

Massive hemoptysis (lobectomy, pneumonectomy) 3. BPF w/ tuberculous empyema (pleuropneumonectomy) 4. Trapped lung following empyema (decortications, thoracoplasty) 5. Persistent localized infection in destroyed lung or distal to bronchostenosis (lobectomy, pneumonectomy) 6. An open, culture-negative cavity (>2cm) in young patient (lobectomy) 7. Localized disease resulting from atypical multidrug resistant organism (lobectomy)

PULMONARY INFECTIONS BRONCHIECTASIS etiology = suppurative lung disease characterized by bronchial dilatation 1. Congenital (Kartagener syndrome) 2. Infection 3. Bronchial obstruction - intrinsic = FB, mucus plug, tumor - extrinsic = enlarged LN 1. Plain CXR & CT scan = dilated bronchi 2. Bronchoscopy LOBECTOMY 1. Failure medical treatment 2. Hemoptysis 3. Isolated lobar bronchiectasis LUNG CYSTS CONGENITAL LOBAR EMPHYSEMA = idiopathic hyperinflation of one lobe usually left upper dt intrinsic weakness of bronchial supporting cartilage - severe respiratory distress in infancy

LUNG ABSCESS 1. Complicating necrotizing pneumonia 2. Aspiration 3. Staph lung abscess in 1st yr of life 4. Systemic sepsis 5. Pulmonary infarction 6. On top of carcinoma or parasitic infection

investigations surgical indications

1. CXR = well-delineated cavity with fluid level 2. CT = differentiate benign & malignant abscess LOBECTOMY 1. Failure medical treatment 2. Massive hemoptysis 3. Malignant abscess

BRONCHOGENIC CYST Develop from aberrant buds from the primitive tracheo-bronchial tree - if separates early hilar/mediastinal cyst - if separates later intrapulmonary lower lobe cyst C/P - pulmonary cyst recurrent infection - mediastinal cyst airway obstruction - may communicate with bronchial lumen - may be single, multiple or multiloculated Investiga tion

SEQUESTRATION = segments of non-functional lung that have no bronchial communication w/ the airway - arterial supply : aorta - VR : pulmonary veins Extralobar Asymptomatic *detected incidentally as triangular shadow in posterior costophrenic angle adjacent to aorta & esophagus excision Intralobar recurrent pneumonia, abscess * in lower lobe * sequelae of high BF to pulmonary system = hemoptysis, CHF

HYDATID CYST

BULLAE = air-filled space within the lung parenchyma - results from intrinsic destruction of alveolar tissue - has fibrous wall - may communicate (open) or not (closed) with bronchial tree - dyspnea (bulla enlarges progressively and compresses normal lung) - complications of bulla (pneumothorax, infection, hemoptysis) 1. CXR, CT 2. V/Q lung scanning 3. PFT

- breathlessness - cough - of expectoration watery fluid or grape-like skin (cyst rupture)

CXR = overinflation of a lobe, mediastinal shift

treatme nt

excision

lobectomy

lobectomy

1. CXR = spherical, well defined opacity w/ or w/o air cap, water lily appearance 2. CT chest 3. Casoni test 4. Serological test - enucleation & capetonage - lobectomy (very large cyst)

- bullectomy - lobectomy (when whole lung is replaced by a large bulla)