MEDIASTINAL CASE STUDIES Patricia K. Abbott MHS PA-C Senior Physician’s Assistant Division of Thoracic Surgery Hospital of University of Pennsylvania
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MEDIASTINAL CASE STUDIES Patricia K. Abbott MHS PA-C Senior Physician’s Assistant Division of Thoracic Surgery Hospital of University of Pennsylvania
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Mediastinal Case Study A mediastinum is an area, a cavity, between 2 portions of an organ The thoracic mediastinum is the area that includes the organs and tissues which separates the right and left lungs
In Thorascopic Surgery, ed. Kaiser LR, Daniel LR.Little, Brown and Co. 1993
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Mediastinal Case Study
32yo male with diagnosis of stage I mediastinal seminoma 2005; s/p radiation therapy Follow up radiographic studies reveal decrease in size of anterior mediastianal mass, but persistant Patient is asymptomatic
Mediastinal Case Study
PMHx: above PSHx: right foot surgery x2 ROS: negative Tobacco History: none Social Hx: Married Engineer
Mediastinal Case Study
CT Scan of the Chest with contrast 8x3cm mass in anterior mediastinum No mediastinal, hilar or axillary lymph nodes No pulmonary nodules seen Visualized upper abdomen WNL PET Scan reveals intense metabolic activity with an SUV=6.2
Mediastinal Case Study
Pre Operative Risk factors Tobacco Use a. Smokeless b. Cigarettes: When patient quit smoking: never smoked c. Tobacco use: select no (vs. yes) d. a + d
Mediastinal Case Study
Answer: c. No –patient never smoked
Mediastinal Case Study
Clinical Staging a. No b. Yes: Clinical Stage TI
Mediastinal Case Study
Answer: a. No – clinical staging in the STS data base is only applicable to lung and esophageal cancers.
Mediastinal Case Study
Mediastinal /Neck (Yes) (No) – Yes a. b. c. d. e.
Anterior mediastinotomy Biopsy, mediastinal mass Resection, mediastinal mass Median sternotomy (for approach) c+d
Mediastinal Case Study
Answer: e. (c + d) The approach is mediansternotomy PLUS the reason for surgery in the mediastinum is to resect the mass in the chest
Mediastinal Case Study
80yo female found to have a 2.5cm right upper lung lesion during evaluation for shortness of breath PET scan is + in RUL and also in mediastinum and hilum TTNA: +NSCLC
Mediastinal Case Study
Symptoms:
Risk Factors:
Tobacco history: 1ppdx33yrs; quit 1979
PMHx:
20lb weight loss over 3months No cough, sputum production or hemoptysis
Hypertension, h/o TIA
PSHx:
Bilateral breast bx (benign) TAH/BSO Cataract procedure Cholecystectomy hemorrhoidectomy
Mediastinal Case Study
9/5/06 patient taken to the operating room for invasive staging Flexible bronchoscopy Transverse incision was made overlying the sternal notch Samples of lymph nodes were taken and forwarded to pathology Patient recovered from anesthesia and was discharged to home
Mediastinal Case Study
Weight loss over last 3 month? a. b. c. d.
20lbs 0 44kg unkown
Mediastinal Case Study
Answer c. 44kgs – weight is recorded in kg and lbs weight loss is recorded in kg