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Thoracic Surgery

Timothy Misselbeck

TEST TAKING TIP

Test Taking Tip

All general surgery residents should have a working knowledge of basic thoracic surgical conditions. Focus on the common problems you may encounter as incidental findings—such as managing a solitary pulmonary nodule or a newly found mediastinal mass. Be familiar with the common surgical approaches such as median sternotomy, posterolateral thoracotomy, etc.

FIGURE 27-1.

The thorax, showing rib cage, pleura, and lung fields. (Reproduced from Doherty GM. Current Diagnosis and Treatment: Surgery. 13th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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ANATOMY/PHYSIOLOGY

Which ribs are true ribs (directly articulate with the sternum by means of cartilages)?

  • The upper 7 ribs (numbered 1–7)

Which ribs are false ribs (no direct connection with sternum anteriorly; usually connect with the costocartilage above)?

  • The lower 5 ribs (numbered 8–10)

Which ribs are floating ribs (articulate only with thoracic spine)?

  • Ribs 11 and 12

What structure perforates and connects the alveoli?

  • The pores of Kohn

What type of epithelium lines the larger upper airways as a single layer?

  • Ciliated tall columnar epithelium

What are type I pneumocytes?

  • Gas exchange; constitute ~40% of the number of cells lining the alveoli and cover >90% of the alveolar lining

What are type II pneumocytes?

  • Granular pneumocytes that contain lipid inclusion bodies and manufacture surfactant, a lipoprotein (dipalmitoyl-lecithin) that decreases surface tension.

What are the lobes and fissures of the right lung?

  • The right lung is composed of 3 lobes: the upper, middle, and lower.

  • The major (oblique) fissure separates the right lower lobe from the right upper and middle lobes.

  • The minor (horizontal) fissure separates the right upper lobe from the right middle lobe.

FIGURE 27-2.

Segmental anatomy of the lungs and bronchi. (Reproduced from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz's Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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What are the lobes and fissures of the left lung?

  • The left lung has 2 lobes—the left upper lobe and the left lower lobe.

  • The lingula is a portion of the left upper lobe and corresponds embryologically to the right middle lobe.

  • A single oblique fissure separates the left upper lobe from the left lower lobe.

What is the blood supply to the lung?

  • Unoxygenated blood is pumped to the ...

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