Case 40 Part 11

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What's inside?


Lung cancer
Pulmonary artery
Lobar artery
Sublobar artery
Cut surface
Hemorrhage
Lymph node
Bronchus




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Discussion Questions

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1. What types of lung cancer are there?
 
 
2. Which ones are associated with smoking?
 
 
3. Identify the tumor in the video. Which lobe is it in?
 
 
4. Identify the hilum. How far away is the tumor from the hilum?
 
 
5. Review the prior videos in this case or infer from your knowledge of anatomy: How far away was the tumor from the lateral chest wall?
 
 
6. How far away was the tumor from the anterior chest wall?
 
 
7. Do you think the tumor would have been easily accessed by biopsy.
 
 
8. Re-think Parts 1 and 2 of this case. Do you think placement of the needle was appropriate, given the location of the tumor?
 
 
9. Why is there hemorrhage around the tumor?
 
 
10. Can you identify a specific blood supply for the tumor?
 
 
11. Based on the appearance of the tumor and its blood supply and knowing the gross and microscopic anatomy of the lung, can you create a scenario where a biopsy would lead to massive intrabronchial hemorrhage?
 
 
12. The autopsy did not identify a specific hole in a specific vessel. Do you think a specific hole would be easy or hard to detect?
 
 
13. The autopsy did not identify a specific hole in a specific vessel. How does this affect your analysis?
 
 
14. Re-think Part 8 of this case. Why now do you think there is hemorrhage seen on the surface of the right upper lobe?
 
 
15. There is a lymph node identified in the video. Find it. What structure is it closest too?
 
 
16. Should this biopsy have been performed? Why or why not?





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Case Notes - About this video

 

This video shows the lung tumor near the end — in the last few seconds of the video.
 
It is part of a larger case where the physician did the biopsy on the tumor and the patient bled to death during the procedure.
 
The blood ended up filling the patient’s airway.
 
This injury and bleeding seem to have been an accident.
 
The large blood vessel growing into the tumor probably explains why the needle could cause bleeding after entering the area.
 
The video mostly shows the pathologist trying to find the hole in the airway that would document where and how the blood got in there.
 
The tumor is shown at the end.
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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