Key Questions in Thoracic Surgery

Moorjani, Narain, Viola, Nicola , Walker, William S.

• Publisher: tfm Publishing Ltd
• Year: 2016
• ISBN:
  9781910079317
• Topic: Medizin
• Subtopic: Chirurgie & chirurgische Medizin

Following on from the success of the international bestseller Key Questions in Cardiac Surgery, the long awaited Key Questions in Thoracic Surgery will be the next book in the Key Questions series to be released. Key Questions in Thoracic Surgery will systematically cover all the main topics involved in the current practice of a thoracic surgeon. It will incorporate current guidelines for practice (such as from the American College of Chest Physicians, British Thoracic Society and European Respiratory Society) and up-to-date information based on current literature. Each chapter will be structured to include etiology, pathophysiology, clinical features, indications for surgery, peri-operative management, surgical options and postoperative care. Possible complications will be discussed and the results of current practice presented. Importantly, there will be a section on basic sciences related to the practising thoracic surgeon and a further section on thoracic investigations with many images illustrating the variety of pathologies. Each chapter will also contain important references for further reading and greater depth of knowledge. The data and body of knowledge presented in this book is strictly evidence-based and is relevant to all thoracic surgical trainees, at any stage of their training programme. It will provide residents, fellows and specialist registrars the necessary information to carry out their daily duties. Respiratory physicians and thoracic intensive care unit specialists will also find the book useful in terms of the indications and surgical management of these patients, as they are integral to the thoracic surgical process. Another important group is the nursing staff, physiotherapists and other professions allied to medicine working with patients with adult thoracic disease either pre-operatively or postoperatively, as it will help to give a detailed understanding of the principles surrounding thoracic surgical disease. Most importantly, the book is ideal as a revision aid for residents/registrars undertaking their Cardiothoracic Surgery Board examinations around the world. Although these examinations vary in format in different countries, this book is applicable to all cardiothoracic surgical trainees. Its concise, yet complete coverage of the important topics, make it the ideal guide to answer the key questions in thoracic surgery that are asked within the confines of an examination.

Chapter 1

Thoracic anatomy

John Pilling

1	Describe the boundaries and compartments of the mediastinum
•	The mediastinum represents the medial compartment of the thorax (Figure 1) and is bounded by the:

a)	left and right pleura (laterally);
b)	sternum and costal cartilages (anteriorly);
c)	vertebral column (posteriorly);
d)	thoracic inlet (superiorly);
e)	diaphragm (inferiorly).

•	The mediastinum itself can be further subdivided into compartments to aid differential diagnosis or plan surgical access:

a)	four-compartment model (Figure 2) - which is subdivided by a line drawn between the sternal angle of Louis and the inferior border of the T4 vertebrae (thoracic plane), and further by the parietal pericardium (see Chapter 35):

Figure 1. Boundaries of the mediastinum.

i)	superior mediastinum - between the thoracic inlet and thoracic plane;
ii)	anterior mediastinum - below the thoracic plane and anterior to the parietal pericardium;
iii)	middle mediastinum - below the thoracic plane and within the parietal pericardium. It also contains the carina and main bronchi;
iv)	posterior mediastinum - below the thoracic plane and posterior to the parietal pericardium;

b)	Felson’s three-compartment model (Figure 3) - where there is no superior compartment:

i)	anterior compartment - which passes from the thoracic inlet superiorly to the diaphragm inferiorly and is bounded posteriorly by the posterior wall of the trachea and anterior pericardium, and anteriorly by the posterior aspect of the sternum and costal cartilages;
ii)	middle compartment - which is bounded anteriorly by the anterior pericardium, posteriorly by the posterior pericardium and posterior wall of...