Presentation is loading. Please wait.

Presentation is loading. Please wait.

FIBROTHORAX AND DECORTICATION OF THE LUNG

Similar presentations


Presentation on theme: "FIBROTHORAX AND DECORTICATION OF THE LUNG"— Presentation transcript:

1 FIBROTHORAX AND DECORTICATION OF THE LUNG
GENERAL THORACIC SURGERY CHAPTER 61

2 Decortication Pelling or stripping a constricting menbrane from the pleural surface. Include– 1). Intercostals incision, wide exploration of pleural cavity. 2). Full mobilization of lung. 3). Remove fibrous peel, not the visceral pleura, 4). Suction and drainage. VATS.

3 Pathophysiology of fibrothorax
cause of fibrothorax table 61-1. pleural fluid undrained, deposits fibrin on visceral and parietal pleura. Thin layer of immatured blood vessel and loose collagen forms. Organization produce dense avascular collagen matrix wall of the insulting fluid. Pulmonary compression, atelectasis. Entrapment of lung, encasement of thoracic cage produces a restrictive ventilatory defect.

4

5 Diagnosis and evaluation
Symptom /Sign— Chest tightness, frank pain, dry nonproductive cough, fatigue, malaise. PE— Unilateral fixation of chest wall, reduce excursion of isilateral hemidiaphragm, dull to percussion, impaired transmission of breath sound.

6 Diagnosis and evaluation
Chest x ray— Obliterate the costophrenic angle, narrow intercostals space, diminished the hemithorax, retraction the mediastinum to the fibrothorax, pleural calcification. CT— Assess the underlying pulmonary parenchyma for tuberculosis, bronchiectasis, mass lesion.

7 Treatment Preoperative evaluation—pulmonary function test, ABG.
Indication and contraindication. Indication— 1). Symptomatic extraparenchymal restrictive disease. 2). Tube thoracostomy, thoracentesis, thoracoscopy are fail to drain and expand of lung.

8 Treatment Timing— 1). Hemothorax over 6 weeks.
2). More than 50% compression. 3). Apex collapse. 4). In tuberculosis after chronic antituberculosis therapy. 5). No changes on chest x-ray.

9 Treatment Contraindication— Major bronchial obstruction.
Pulmonary destruction. Uncontrol sepsis. Chronic debilitation. Concomitant organ dysfuction.

10 Differential diagnosis
Mesothelioma. Malignancy. Metastatic pleural disease.

11 Technique Bronchoscope exclude endobronchial lesion.
Posterior lateral thoracotomy. Resection ribs. Blunt dissection the parietal peel, plane between the endothoracic fascia and parietal pleura.

12 Technique Prevent injury of diaphragm and phrenic nerve.
Thicked parietal peel in incised. Empyectomy with preservation the integrity of cavity for tuberculosis. Perioperative antibiotics, material is cultured. Pulmonary decortication with incision fibrous peel overlying the visceral pleura. Chest tube drainage.

13

14

15

16

17

18 Mortality and morbidity
Morbidity— Sepsis, wound infection, empyema, hemorrhage, prolong air-leak, bronchopleural fistula. Result— Absence of underlying parenchymal disease is best improve. Phrenic nerve injury, tuberculosis are less improve.


Download ppt "FIBROTHORAX AND DECORTICATION OF THE LUNG"

Similar presentations


Ads by Google