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Bronchoscopy with Biopsy Medical Transcription Sample

DATE OF PROCEDURE: MM/DD/YYYY

PREOPERATIVE DIAGNOSES:
1. Hemoptysis.
2. Right lung mass.

POSTOPERATIVE DIAGNOSES: Not given.

PROCEDURE PERFORMED: Bronchoscopy with brushing and biopsy.

DESCRIPTION OF PROCEDURE: Informed consent was obtained from the patient. Procedure and the complications including complication of anesthesia, pneumothorax requiring chest tube, bleeding complication, arrhythmia, hypoxia, need for ventilation was explained to the patient and he consented for the procedure.

The patient was brought to the operating suite. Under general anesthesia, endotracheal tube was placed by anesthesiologist. Bronchoscopy was done through endotracheal tube. Distal trachea is normal. Main carina is sharp. Bronchoscope was advanced to the left lung. Left upper lingula and lower lobe were visualized up to subsegmental level. All subsegments are patent. No endobronchial or mucosal lesions were seen. The bronchoscope was further advanced to the right lung. Right upper, middle and lower lobe were visualized. All subsegments are patent. No endobronchial obstructing or mucosal lesions were seen. Right lower lobe bronchoalveolar lavage and brushing was done. It was sent for cytology. Right upper lobe bronchoalveolar lavage, brushing and biopsies were done. Biopsies sent for pathology. Bronchoalveolar lavage sent for cytology. Brushing sent for cytology. The patient tolerated the procedure well. Postprocedure chest x-ray to rule out pneumothorax.

DATE OF OPERATION:  MM/DD/YYYY

OPERATION PERFORMED:
1.  Fiberoptic bronchoscopy.
2.  Cervical mediastinotomy with frozen section.
3.  Video-assisted thoracoscopic surgery, right lower lobe resection.
4.  Mediastinal lymphadenectomy.

SURGEON:  John Doe, MD

DESCRIPTION OF PROCEDURE:  With the patient in the supine position on the operating room table, after the induction of double-lumen endotracheal anesthesia, fiberoptic bronchoscopy down to the subsegmental level was performed.  There was no evidence of endobronchial pathology.  Cervical mediastinotomy with frozen section biopsy was then performed via routine technique and the frozen section report was negative for metastatic carcinoma to the N2 nodes.

We then positioned the patient right side up and prepped and draped for a posterolateral thoracotomy.  A couple of ports were introduced to the 5th and 7th intercostal spaces; unfortunately, we did not have good single lung isolation, and this complicated the performance of the procedure quite greatly.  We did begin performing the right lower lobectomy by starting with a mini thoracotomy incision measuring perhaps 6 to 8 cm in size in the 5th intercostal space.  Soft tissue retractor was positioned, and we started and had good exposure.

We then mobilized the inferior pulmonary ligament and performed mediastinal lymph node dissection.  We could initially not see the mass very easily, partially because of the lung not being well deflated.  We did mobilize and divide the inferior pulmonary vein and divided this with a vascular Endo GIA stapler and then we also identified the pulmonary arterial supply to the lower lobe, which was in the fissure and divided this with the vascular stapler.  We completed the remainder of the resection with the Endo GIA 45 EZ stapling device.  At this point, lymph node sampling was performed throughout the mediastinum and represented samples are included in the pathology report.

Unfortunately, upon removing the specimen, we could not find any evidence of the tumor still within the pathology.  We did examine within the chest and found that there was a mass really adherent to the ribs at T6-T7, so that we had to perform a limited chest wall resection.  This was biopsied intraoperatively and found to be consistent with a schwannoma.  This was probably at the T6 nerve root.  We did perform intraoperative consultation with a neurosurgeon who, as noted previously, did perform intraoperative consultation.

We performed resection of T6-T7 in its entirety, and there was some erosion of this schwannoma into the rib space.  We had a small amount of dural leaking, so we used CoSeal to form a dural patch and secured hemostasis.  We then placed a single chest tube and closed the chest using #1 Tevdek repair across the suture, running 0 Maxon, running 2-0 Vicryl, running 3-0 Vicryl.  Steri-Strips and sterile dressing were applied to the wounds.  The patient tolerated the procedure well and was brought to the recovery room in satisfactory condition.

Pulmonary Operative Samples          Fiberoptic Bronchoscopy Sample