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Pneumonectomy / Lobectomy Pneumonectomy signs Left/right thoracotomy scar On affected side o Tracheal displacement to side of removal o Reduced expansion o Dull percussion note o No breath sounds (although there may be bronchial breathing in the upper zone due to tracheal deviation Lobectomy signs Left/right thoracotomy scar Usually no other signs Chest X-Ray Fluid fills cavity of removed lung (radio-opaque) Organs shift into cavity of removed lung (i.e. heart and trachea displaced) Indications Lung malignancy Old TB Localised bronchiectasis Aspergilloma Large bullectomy Lung lesion workup CT chest/abdo/pelvis + PET o Confirm no metastasis Attain histology o CT-guided biopsy/bronchoscopy/mediastinoscopy Pulmonary function tests o FEV1 > 2L = operate o FEV1 < 2L = ventilation perfusion scanning to determine split lung function © 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision