Case 40 Part 11

(Demo for tour)




What's inside?



 

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



Discussion Questions



 

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? How far away is it from the hilum? How far away was it from the lateral chest wall? How far away was it from the anterior chest wall? Do you think the tumor would have been easily accessed by biopsy. Re-think Parts 1 and 2. Do you think the location of the biopsy tract was appropriate, given the location of the tumor?
 
 
4. Why is there hemorrhage around the tumor?
 
 
5. Can you identify a specific blood supply for the tumor?
 
 
6. Based on the appearance of the tumor and its blood supply and knowing the gross and microscopic anatomy of the lung, can you created a scenario where a biopsy would lead to massive intrabronchial hemorrhage?
 
 
7. The autopsy did not identify a specific hole in a specific vessel. How does this affect your analysis? Do you think a specific hole would be easy or hard to detect?
 
 
8. Re-think Part 8. Why now do you think there is hemorrhage seen on the surface of the right upper lobe?
 
 
9. There is a lymph node identified in the video. Find it. What structure is it closest too?
 
 
10. The simplest explanation for bleeding into the airway would be if the needle had created an iatrogenic fistula between an artery and a bronchus? Was this found? Did this happen? Do you think this kind of hole could be identified at autopsy?
 
 
11. Should this biopsy have been performed? Why or why not?




Anatomy Pins



 
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Instructions:
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1. Lung: right upper lobe
2. Lung: right middle lobe
3. Lung: diaphragmatic surface right lower lobe
4. External right pulmonary artery at hilum (lateral view)
5. Lymph node
6. Right pulmonary artery
7. Lobar pulmonary artery (to right lower lobe)
8. Branch of pulmonary artery (towards right upper lobe)
9. Right mainstem bronchus
10. Secondary bronchi
11. Right mainstem bronchi
12. Secondary bronchi
13. Right mainstem bronchi
14. Branch of right pulmonary artery
15. Right pulmonary artery
16. Tumor
17. Branch of right pulmonary artery

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