My partner was due to have a laparoscopy of an ovarian cyst today. However, she saw a pulmonologist yesterday morning because she tested positive for COVID-19 the previous day. The pulmonologist did some scans and found mild dilatation of the pulmonary cone.
He told her that she could no longer have the laparoscopy of ovarian cyst because of this. And did not provide her with any alternatives. He said that her lungs would not be able to cope with the anesthesia. Her other doctor, who was due to perform the laparoscopy, had previously said that the ovarian cyst is very bad and needs urgent removal.
Please could you review the two attached letters from the pulmonologist and the scan report? She has no respiratory symptoms such as cough, chest pain, or breathing difficulty. We would like to know your thoughts on what the pulmonologist has said. Do you agree that it would not be safe to perform the operation? If so, what alternatives can you recommend? Is there anything to be done to fix the lungs? Please help.
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I can understand your concern. According to your statement, your partner has been suffering from ovarian cyst pain for the last two to three weeks. Laparoscopic surgery of ovarian cyst was postponed due to her pulmonologist findings of mild dilatation of the pulmonary cone on her HRCT of chest, according to your description. She was COVID-19 positive.
According to her, HRCT (high resolution computed tomography) of the chest has revealed that baseline fibroatelectatic changes bilaterally. And small pneumatocele in the right segments 6 and 8.
Well, atelectatic changes bilaterally have been found on her HRCT of the chest. Atelectasis is a complete or partial collapse of the area or lobe of the lung. It occurs when the tiny air sacs or alveoli within the lung become deflated or possibly filled with alveolar fluid.
Risk factors for atelectasis are anesthesia during the operation, mucus that plugs the airway, underlying lung diseases, etc. Atelectasis can be aggravated, which is the most common life-threatening breathing or respiratory after surgery. Atelectasis is sometimes asymptomatic and shows no clinical features like cough, breathing difficulties, etc. It usually gets better with time or treatment. But it is undiagnosed or untreated, and then serious complications may occur like pneumonia, respiratory failure, etc.
Again, pneumatocele has been found on her lung. They are thin-walled, air-filled cysts or emphysematous lesions which develop on the lung. They may have resulted as a consequence of pneumonia, hematoma, lung injury, pulmonary trauma, COPD (chronic obstructive lung disease), etc.
According to your partner's HRCT of the chest, it is obvious that she needs treatment for her lung's findings as well as rest. Any type of surgery may aggravate her asymptomatic atelectasis and pneumatocele and cause severe respiratory distress, respiratory failure, etc. For that reason, her pulmonologist has advised her not to undergo surgery.
Thank you doctor,
Is this lung condition treatable? What are the treatment options, and what is the predicted time scale before she could have the surgery? Also, would it be possible to have the operation now with a different form of anesthesia? For example, spinal or something? Is there any other way to do the surgery now, which would be safe?
Welcome back to icliniq.com.
Yes, her lung condition is treatable. Treating atelectasis depends on the underlying cause and how severe her symptoms are. If she has been suffering from a cough, she can take bronchodilators like Salbutamol with or without antibiotics like Azithromycin. Otherwise, no treatment is needed without chest physiotherapy or breathing exercises.
Breathing exercise may be performed using an incentive spirometer that forces her to breathe in deeply and help open up the alveoli or blow the balloons with air. She can consult with a chest physiotherapist for physiotherapy that will help loosen and drain mucus. It is difficult to predict the duration of time when she will fit for surgery. It may take a few days to months, depending on the causes. An MRI c(magnetic resonance imaging) chest or bronchoscopy can be done to exclude the causes.
General anesthesia is a common cause of atelectasis. Nearly everyone who has major surgery develops some amount of atelectasis. If your partner is scheduled for surgery, talk to her doctor about strategies to reduce her risks. Certain breathing exercises and muscle training may lower the risk of atelectasis after surgeries.
During induction of anesthesia, the application of PEEP of 6 cm H2O can prevent atelectasis and increase the margin of safety before intubation.
Again, epidural anesthesia causes no or little atelectasis and no change in shunting, ventilation/ perfusion ratio. As your partner has not presented signs and symptoms of atelectasis, discuss with her surgeon and anesthesiologist along with her HRCT of chest report. They will find a way to operate her ovarian cyst. They can also advise doing some more investigations like pulmonary function test, ABG (arterial blood gas) analysis, oxygen saturation rate by a pulse oximeter, MRI chest or bronchoscopy, etc. After examining the reports of these investigations, they will fix the probable date for the operation.
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