www.surgicalnotes.co.uk

Approach

• Position as for chest examination
• Begin with hands
• Expect to move directly to chest wall

1. Inspect
   • Lateral thoractomy scar over chest wall (5/6th intercostal space and curves posteriorly and upwards ending midway between the spine of the scapula and the thoracic vertebral spaces)

     

   • Scars at sites of chest drains may be present
   • Muscle bulk over the side of scar may be reduced as parts of serratus anterior and latissmus dorsi may have been removed
2. Palpation
   • Trachea deviated away from the side of surgery
   • Expansion will be reduced over the side of surgery
3. Percussion
   • Hyper-resonant over the side of surgery
4. Auscultation
   • Breath sounds harsher over the side of the pneumonectomy

Indications for lung resection

1. Lobectomy = exicision of single lobe
2. Pneumonectomy = excision of entire lung
3. Sleeve resection = resection of lobe including bronchial origin with re-anastamosis of the proximal and distal bronchus