TWilliam2019
Guru
These are my weakness
I was looking at either 32608, 32609, 32650
any suggestions is greatly appreciated thanks
Postoperative diagnosis:
#1 bilateral pleural effusions
#2 bilateral pleural-based masses
#3 calyces in
#4 pneumonia
procedure:
#1 left VATS with biopsy of subpleural mass
#2 evacuation of left pleural effusion
Procedure:
28-year-old male with history of thalassemia admitted with fevers, chills and was treated for pneumonia. CT scan revealed bilateral pleural effusions which were recurrent after centesis was performed. It also revealed pleural placed masses bilaterally. He presents for definitive workup.
Specimens:
- Left pleural fluid for cytology and cultures
- left subpleural intercostal cystic mass biopsy for permanent pathology
estimated blood loss: Less than 5 mL's
blood replaced: None
drains: Chest tube as described
implants: None
condition at the completion of procedure: Stable
Intraoperative findings:
- 550 mL of serous fluid removed from the left pleural cavity
- lung parenchyma and visceral pleura appeared normal
- no malignant process involving the mediastinum and diaphragm
- parietal pleura was mildly injected, but overall normal
- dark hued subpleural masses identified both anteriorly and posteriorly in the intercostal spaces. Image was saved for permanent records. Upon opening the pleura, these were cystic in nature with contents that were consistent with thrombus. Pathology was submitted as a permanent specimen.
Procedure in detail:
The patient had his history and physical updated prior to the procedure. He was transferred to the operating suite and placed on the operating table where he underwent general anesthesia with double-lumen endotracheal intubation. He was then placed in the lateral recumbent position after anesthesia placed monitoring devices. The left chest was prepped and draped in usual sterile fashion using ChloraPrep solution. Timeout was used confirm patient identity as well as the procedure to be performed. Antibiotics given prior the incision. Next
A 5 mm incision was made at the posterior axillary line, roughly the eighth intercostal space. Access into the left pleural cavity was achieved using the Optiview technique. Upon entering the left pleural space, serous fluid was immediately evident. Portions of this fluid was collected in traps and submitted for cytology as well as routine, AFB, and fungal cultures. Once this was completed, the VATS camera was inserted PA was responsible for navigating the VATS camera.
A second 10 mm incision was made anteriorly at roughly the fifth intercostal space. Access in the left pleural cavity was achieved. The lung was carefully retracted anteriorly and the remainder of the pleural effusion was removed. The pleural cavity was then grossly inspected with findings as described. Once this was completed, at approximately the fourth intercostal space, the pleura was opened posteriorly which revealed a cystic-like mass in the interspace. Using a cup biopsy forcep, this cystic mass was biopsied with portions of its wall as well as his internal contents being removed and submitted to pathology. There was excellent hemostasis at the completion of the procedure.
A 28 French straight chest tube was placed via the most inferior incision and secured with 0 silk. The lung was ventilated under direct visualization and found to be fully re expanded. The incisions were injected with half percent Marcaine for local anesthesia. The soft tissues reapproximated with 2-0 Vicryl. The skin was closed with 4-0 Monocryl in a running subcuticular manner. Dermabond was placed over the wound. The patient tolerated procedure well, was estimated, then transferred recovery.
I was looking at either 32608, 32609, 32650
any suggestions is greatly appreciated thanks
Postoperative diagnosis:
#1 bilateral pleural effusions
#2 bilateral pleural-based masses
#3 calyces in
#4 pneumonia
procedure:
#1 left VATS with biopsy of subpleural mass
#2 evacuation of left pleural effusion
Procedure:
28-year-old male with history of thalassemia admitted with fevers, chills and was treated for pneumonia. CT scan revealed bilateral pleural effusions which were recurrent after centesis was performed. It also revealed pleural placed masses bilaterally. He presents for definitive workup.
Specimens:
- Left pleural fluid for cytology and cultures
- left subpleural intercostal cystic mass biopsy for permanent pathology
estimated blood loss: Less than 5 mL's
blood replaced: None
drains: Chest tube as described
implants: None
condition at the completion of procedure: Stable
Intraoperative findings:
- 550 mL of serous fluid removed from the left pleural cavity
- lung parenchyma and visceral pleura appeared normal
- no malignant process involving the mediastinum and diaphragm
- parietal pleura was mildly injected, but overall normal
- dark hued subpleural masses identified both anteriorly and posteriorly in the intercostal spaces. Image was saved for permanent records. Upon opening the pleura, these were cystic in nature with contents that were consistent with thrombus. Pathology was submitted as a permanent specimen.
Procedure in detail:
The patient had his history and physical updated prior to the procedure. He was transferred to the operating suite and placed on the operating table where he underwent general anesthesia with double-lumen endotracheal intubation. He was then placed in the lateral recumbent position after anesthesia placed monitoring devices. The left chest was prepped and draped in usual sterile fashion using ChloraPrep solution. Timeout was used confirm patient identity as well as the procedure to be performed. Antibiotics given prior the incision. Next
A 5 mm incision was made at the posterior axillary line, roughly the eighth intercostal space. Access into the left pleural cavity was achieved using the Optiview technique. Upon entering the left pleural space, serous fluid was immediately evident. Portions of this fluid was collected in traps and submitted for cytology as well as routine, AFB, and fungal cultures. Once this was completed, the VATS camera was inserted PA was responsible for navigating the VATS camera.
A second 10 mm incision was made anteriorly at roughly the fifth intercostal space. Access in the left pleural cavity was achieved. The lung was carefully retracted anteriorly and the remainder of the pleural effusion was removed. The pleural cavity was then grossly inspected with findings as described. Once this was completed, at approximately the fourth intercostal space, the pleura was opened posteriorly which revealed a cystic-like mass in the interspace. Using a cup biopsy forcep, this cystic mass was biopsied with portions of its wall as well as his internal contents being removed and submitted to pathology. There was excellent hemostasis at the completion of the procedure.
A 28 French straight chest tube was placed via the most inferior incision and secured with 0 silk. The lung was ventilated under direct visualization and found to be fully re expanded. The incisions were injected with half percent Marcaine for local anesthesia. The soft tissues reapproximated with 2-0 Vicryl. The skin was closed with 4-0 Monocryl in a running subcuticular manner. Dermabond was placed over the wound. The patient tolerated procedure well, was estimated, then transferred recovery.
