Chotupa chamkati

Zotupa zamkati ndi zophuka zomwe zimapanga mediastinum. Awa ndi malo omwe ali pakati pachifuwa omwe amalekanitsa mapapu.

Mediastinum ndi gawo la chifuwa chomwe chagona pakati pa sternum ndi khosi la msana, komanso pakati pa mapapo. Dera ili lili ndi mtima, mitsempha yayikulu yamagazi, chopumira (trachea), thymus gland, esophagus, ndi ziwalo zolumikizira. Mediastinum imagawidwa m'magawo atatu:

• Zakutsogolo (kutsogolo)
• Pakati
• Kumbuyo (Kumbuyo)

Zotupa zamkati sizimapezeka.

Malo omwe amapezeka zotupa mu mediastinum zimadalira msinkhu wa munthu. Kwa ana, zotupa ndizofala kwambiri pambuyo pa mediastinum. Zotupa izi zimayamba m'mitsempha ndipo sizimayambitsa khansa (zabwino).

Zotupa zambiri zamkati mwa akulu zimachitika mkati mwa mediastinum. Nthawi zambiri amakhala ndi khansa (yoyipa) yamatenda am'mimba, zotupa zamagulu anyongolotsi, kapena thymomas. Zotupa izi ndizofala kwambiri pakati pa achikulire komanso achikulire.

Pafupifupi theka la zotupa zamkati sizimayambitsa zizindikiro ndipo zimapezeka pachifuwa cha X-ray pazifukwa zina. Zizindikiro zomwe zimachitika zimachitika chifukwa chakukakamizidwa (kuponderezana) kwa malo amderalo ndipo atha kukhala:

• Kupweteka pachifuwa
• Malungo ndi kuzizira
• Tsokomola
• Kutsokomola magazi (hemoptysis)
• Kuopsa
• Kutuluka thukuta usiku
• Kupuma pang'ono

Mbiri ya zamankhwala ndikuwunika kwakuthupi kumatha kuwonetsa:

• Malungo
• Phokoso lakumapuma kwambiri (stridor)
• Kutupa kapena ma lymph node (lymphadenopathy)
• Kuchepetsa mwangozi
• Kutentha

Mayesero ena omwe angachitike ndi awa:

• X-ray pachifuwa
• Chithunzithunzi chothandizidwa ndi CT
• Kujambula kwa CT pachifuwa
• Mediastinoscopy yokhala ndi biopsy
• MRI ya chifuwa

Chithandizo cha zotupa zamkati chimadalira mtundu wa chotupa ndi zizindikilo zake:

• Khansa yolimbitsa thupi imathandizidwa ndikuchitidwa opaleshoni. Itha kutsatiridwa ndi radiation kapena chemotherapy, kutengera gawo la chotupacho komanso kupambana kwa opaleshoniyi.
• Zotupa zam'magazi zimachiritsidwa ndi chemotherapy.
• Kwa ma lymphomas, chemotherapy ndi mankhwala osankhidwa bwino, ndipo mwina amatsatiridwa ndi radiation.
• Kwa zotupa za neurogenic zam'mbuyomu mediastinum, opaleshoni ndiyo chithandizo chachikulu.

Zotsatira zimadalira mtundu wa chotupa. Zotupa zosiyanasiyana zimayankha mosiyana ndi chemotherapy ndi radiation.

Zovuta za zotupa zamkati zimaphatikizapo:

• Kupsinjika kwa msana
• Kufalikira kuzipinda zapafupi monga mtima, kuzungulira mozungulira mtima (pericardium), ndi zotengera zazikulu (aorta ndi vena cava)

Poizoniyu, maopareshoni, komanso chemotherapy zitha kukhala ndi zovuta zazikulu.

Lumikizanani ndi omwe amakuthandizani ngati mukuwona kuti muli ndi chotupa cham'mimba.

Thymoma - wapakati; Lymphoma - yapakati

• Mapapo

Cheng GS, Varghese TK, Park DR. Zotupa zapakati ndi zotupa. Mu: Broaddus VC, Mason RJ, Ernst JD, et al, olemba. Murray ndi Nadel's Bookbook of Respiratory Medicine. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier Saunders; 2016: chap 83.

Malangizo: McCool FD. Matenda a chotupa, khoma pachifuwa, pleura, ndi mediastinum. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. 26 wa. Philadelphia, PA: Elsevier; 2020: chap 92.