The trachea or wind pipe has lymph nodes running alongside it. These lymph nodes drain the lymph tissue from the lung. Occasionally, lung disease will involve these lymph nodes. In order to determine a diagnosis to aid your doctor in your treatment, we will biopsy one of these nodes. This involves a small incision at the base of your neck and passing a scope to this area to obtain a biopsy.
There are other occasions where we will need to biopsy the lung directly. This can often be performed through the video endoscope. Using general anesthesia, we insert the scope through the chest and inspect the entire chest cavity. The appropriate portion of the lung is selected and a wedge of this tissue can be removed. In addition, fluid and lung cysts can be removed through the same minimally invasive small incision.
When there is a mass in the lung, we may resect a portion of one lung or occasionally all of the lung. The right lung is divided into three segments, the left into two. Usually, we will remove one of these segments. Before removing any lung, we first inspect to see if the disease process involves the lymph node tissue or the chest wall itself. In some circumstances, we may not remove the lung lesion if the disease has spread elsewhere. After removal of a portion of the lung, the remaining lung will expand to fill the empty space. There will also be small areas of the lung that will leak some air for a few days and then usually stop. As these two processes occur, you will have chest tubes which drain fluid and air and help the lung to re-expand.
Esophageal ruptures and perforations are usually caused by violent vomiting. This can lead to tissue inflammation in the chest and allow fluid to enter the pleural space. Surgical repair of the esophagus and drainage of the area are performed immediately. Esophageal cancer is a very serious diagnosis requiring resection of part or all of the esophagus. The surgery is complex and the patient is often in the intensive care unit for an extended period following the surgery.
Patent Ductus Arteriosus
An infant that has been diagnosed with Patent ductus arteriosus may undergo a surgical procedure to repair it. An incision is made in the left chest and the PDA is identified. A clip is used to ligate the PDA. Most infants tolerate the procedure well and have little long-term effects from this condition.
Repair of Chest Wall Deformities
A midline incision is made over the sternum and the cartilage connecting the rins and sternum are removed. The sternum is then fractured and the defect is corrected by suturing the sternum in correct placement. The hospital recovery period is usually four to six days. Patients often are able to eat soft foods and walk around the room the evening of surgery. After discharge, patients are strongly encouraged to lift weights to increase the strength of the chest wall muscles.