Manual of Thoracic Surgery, 2nd Edition by Arndt Von Hippel

By Arndt Von Hippel

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It appears that rapid removal of massive ascites can be dangerous Case report: The old tub overflowed Case report: If a little feels good, a lot can kill you Peritoneovenous shunting prevents hypovolemia Pleural effusion with pancreatitis Venous cannulation may cause pneumothorax or air embolism Pleural effusion may represent misdirected intravenous fluids Entrapped, shrunken or atelectatic lung resists reexpansion Pulmonary edema has been reported following reexpansion of lung Serous effusion Bloody effusion Feel for scalene nodes Pleural malignancy Malignant pleural effusion Tetracycline treatment may prevent recurrence of a malignant pleural effusion Pleural plaques A pleasant surprise: Hemothorax not due to malignancy will usually absorb When is it imperative to evacuate a hemothorax?

Take care during dissection along diaphragm. Anatomy Lined by pleura above and peritoneum below, thin but powerful diaphragm muscles separate thoracic and abdominal contents. Each hemidiaphragm is innervated by its separate phrenic nerve, traveling down the lateral mediastinal surface and pericardium, passing anterior to lung hilum from the neck. The pain of diaphragm inflammation or injury may appear to originate from the same side of the upper abdomen and around back, or from shoulder or neck.

While identification and repair of any diaphragm defect can proceed via chest or abdomen, liver can interfere with transabdominal exposure of the right hemidiaphragm and retrohepatic vena cava. For diaphragm repair by posterolateral thoracotomy, the seventh interspace is generally most satisfactory; an eighth interspace approach frequently places one behind a bulging lateral diaphragm that must then Page 7 be retracted in order to gain more medial access. either a vertical midline or transverse upper-abdominal incision can provide excellent exposure of the diaphragm at laparotomy: A strong table-mounted retractor is of great help during transabdominal diaphragm repair (I use interrupted, 2-0, non-absorbable suture).

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