Pancoast tumors are identified as involving all of the following EXCEPT:
Carcinoma arising in the extreme apex of the chest with associated arm and shoulder pain, atrophy of the muscles of the hand, and Horner syndrome presents a unique challenge to the surgeon. Any tumor of the superior sulcus, including tumors without evidence for involvement of the neurovascular bundle, is now commonly known as Pancoast tumors, after Henry Pancoast who described the syndrome in 1932. The designation is reserved for tumors involving the parietal pleura or deeper structures overlying the first rib. Chest wall involvement at or below the second rib is not a Pancoast tumor. Treatment is multidisciplinary; due to the location of the tumor and involvement of the neurovascular bundle that supplies the ipsilateral extremity, preserving postoperative function of the extremity is critical.
The most likely cause of aspiration pneumonia is:
Normal oropharyngeal secretions contain many more Streptococcus species and more anaerobes (approximately 1 x 108 organisms/mL) than aerobes (approximately 1 x 107 organisms/mL). Pneumonia that follows from aspiration, with or without abscess development, is typically polymicrobial. An average of two to four isolates present in large numbers have been cultured from lung abscesses sampled percutaneously. Overall, at least 50% of these infections are caused by purely anaerobic bacteria, 25% are caused by mixed aerobes and anaerobes, and 25% or fewer are caused by aerobes only. In nosocomial pneumonia, 60 to 70% of the organisms are gram-negative bacteria, including Klebsiella pneumoniae, Haemophilus influenzae, Proteus species, Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, and Eikenella corrodens. Immunosuppressed patients may develop abscesses because of the usual pathogens as well as less virulent and opportunistic organisms such as Salmonella species, Legionella species, Pneumocystis carinii, atypical mycobacteria, and fungi.
Laboratory evaluation of a chest wall mass showing elevated erythrocyte sedimentation rates indicates:
Laboratory evaluations are useful in assessing chest wall masses for the following:
The most common benign chest wall tumor is:
Chondromas, seen primarily in children and young adults, are one of the more common benign tumors of the chest wall. They usually occur at the costochondral junction anteriorly and may be confused with costochondritis, except that a painless mass is present. Radiographically, lesion is lobulated and radiodense; it may have diffuse or focal calcifications; and it may displace the bony cortex without penetration. Chondromas may grow to huge sizes ifleft untreated. Treatment is surgical resection with a 2-cm margin. Large chondromas may harbor well-differentiated chondrosarcoma and should be managed with a 4-cm margin to prevent local recurrence.
Which of the following is an indication for surgical drainage of a lung abscess?
Surgical drainage oflung abscesses is uncommon since drainage usually occurs spontaneously via the tracheobronchial tree. Indications for intervention are listed in Table below.
Indications for surgical drainage procedures for lung abscesses:
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