curs pulmon+cord bft modif
Post on 13-Aug-2015
117 Views
Preview:
TRANSCRIPT
I.I.ACUTEACUTE: -: -BACTERIENE:BACTERIENE:
-BACTERIENE SUPURATIVE;-BACTERIENE SUPURATIVE;
-VIRALE (“ATIPICE”);-VIRALE (“ATIPICE”);
IIII.CRONICE.CRONICE::--TUBERCULOZA;TUBERCULOZA;
-Alte boli cu componenta -Alte boli cu componenta inflamat.inflamat.
EtiologieEtiologie:-infectia cu pneumococ,streptococ,etc.:-infectia cu pneumococ,streptococ,etc.
Aspect radiologic: - opacitate sistematizata (segmentara sau lobara) Aspect radiologic: - opacitate sistematizata (segmentara sau lobara)
- intensitate medie- intensitate medie
- omogena - omogena
- bronhograma aerica prezenta- bronhograma aerica prezenta
- imprecis conturata - imprecis conturata
- forma aproximativ triunghiulara cu varful catre hil- forma aproximativ triunghiulara cu varful catre hil
- delimitarea data de o scizura determina netitatea - delimitarea data de o scizura determina netitatea conturului.conturului.
Evolutie – extensie homo sau contralateralaEvolutie – extensie homo sau contralaterala
- resorbtie completa - resorbtie completa centripeta sau centrifuga centripeta sau centrifuga
ComplicatiiComplicatii:-pleurezii-para/meta-pneumonice:-pleurezii-para/meta-pneumonice -abces secundar.-abces secundar.
PNEUMONIE BACTERIANA LOB MEDIUPNEUMONIE BACTERIANA LOB MEDIU
LATERALLATERAL
PNEUMONIE BACTERIANA LOB MEDIUPNEUMONIE BACTERIANA LOB MEDIU
PNEUMONIE BACTERIANA LOB SUPERIORPNEUMONIE BACTERIANA LOB SUPERIOR
PNEUMONIE BACTERIANA PLURISEGMENTARAPNEUMONIE BACTERIANA PLURISEGMENTARA
FOCARE PNEUMONICEFOCARE PNEUMONICE
MULTIPLEMULTIPLE
FOWLERFOWLER
LINGULALINGULA
PNEUMONIE BACTERIANA:diagnostic diferentialPNEUMONIE BACTERIANA:diagnostic diferential
Pneumonie bacterianaPneumonie bacteriana Atelectazie:cancer endobronsicAtelectazie:cancer endobronsic
PNEUMONIE BACTERIANA ACUTAPNEUMONIE BACTERIANA ACUTA
BRONHOGRAMA AERICABRONHOGRAMA AERICA
EtiologieEtiologie:streptococ,pneumococ,Friedlander,..colibacil etc.:streptococ,pneumococ,Friedlander,..colibacil etc.
Frecventa maxFrecventa max:-nou nascut,batrin,imunodeficienta (SIDA);:-nou nascut,batrin,imunodeficienta (SIDA);
HistopatologieHistopatologie: -nodulul bronhiolo-alveolar:-mici (acin);: -nodulul bronhiolo-alveolar:-mici (acin); -mari (lobul);-mari (lobul);
Aspecte radiologiceAspecte radiologice::-grad I-II;diseminare bilat.asimetrica;-grad I-II;diseminare bilat.asimetrica; -respecta bazele si apexul;-respecta bazele si apexul; -contur fluu (congestie);-contur fluu (congestie); -centru opac (bronsiola obstruata);-centru opac (bronsiola obstruata); -confluiaza=>pseudolobar;-confluiaza=>pseudolobar; -asincronism evolutiv;-asincronism evolutiv; -asociaza emfizem bulos,travee opace;-asociaza emfizem bulos,travee opace;
Forme specifice:Forme specifice:-tbc:evol.subacuta,noduli excavati=caverne-tbc:evol.subacuta,noduli excavati=caverne -stafilococica:-pneumatocele,complicatii-stafilococica:-pneumatocele,complicatiisupurative (piotorax,abcese multiple);gravitate majora !supurative (piotorax,abcese multiple);gravitate majora !
BRONHOPNEUMONIEBRONHOPNEUMONIE
BRONHOPNEUMONIEBRONHOPNEUMONIE
BRONHOPNEUMONIEBRONHOPNEUMONIE
FORMA PSEUDOLOBARAFORMA PSEUDOLOBARA
ABCESUL ABCESUL PULMONARPULMONAR
Mec.patogenic:Mec.patogenic:-bronhogen(aerogen..abcedarea pneumoniei);-bronhogen(aerogen..abcedarea pneumoniei); -hematogen(septico-pioemie);-hematogen(septico-pioemie); -contiguitate(plagi,fracturi,post-operator);-contiguitate(plagi,fracturi,post-operator);
Etiologie:-amoebian,stafilo,strepto,Friedlander,etc.
Aspect radiologicAspect radiologic
a)a)Constituire – opacitate rotunjita, contur imprecis, omogena, Constituire – opacitate rotunjita, contur imprecis, omogena, noduli perilezionalinoduli perilezionali
b)b)Supuratie colectata – imagine hidroaerica cu nivel orizontal, Supuratie colectata – imagine hidroaerica cu nivel orizontal, imobila cu miscarile pacientului, contur interior initial imobila cu miscarile pacientului, contur interior initial anfractuosanfractuos
• Infiltrat pneumonic perilezionalInfiltrat pneumonic perilezionalEvolutieEvolutie:-vindecare;sechele fibroase;:-vindecare;sechele fibroase; -cronicizare…=>trat.chirurgical-cronicizare…=>trat.chirurgical
ABCES PULMONAR:faza ABCES PULMONAR:faza pre-vomicapre-vomica
ABCES PULMONAR:faza ABCES PULMONAR:faza pre-vomicapre-vomica
ABCES PULMONAR ABCES PULMONAR SECUNDARSECUNDAR
ABCES PULMONAR ABCES PULMONAR SECUNDARSECUNDAR
Nivel hidroaericNivel hidroaeric
pneumonie
pleureziepleurezie
ABCES PULMONAR SECUNDAR PNEUMONIEIABCES PULMONAR SECUNDAR PNEUMONIEI
ABCES ABCES PULMONARPULMONAR
IN FAZA IN FAZA CRONICACRONICA
““CHIRURGICAL”CHIRURGICAL”
ABCES ABCES PULMONARPULMONAR
IN FAZA IN FAZA CRONICACRONICA
““CHIRURGICAL”CHIRURGICAL”
PNEUMONII INTERSTITIALE, ATIPICEPNEUMONII INTERSTITIALE, ATIPICEEtiologieEtiologie:-virusuri:-influenzae(gripa!),paragripale,adenovirus,respirat.:-virusuri:-influenzae(gripa!),paragripale,adenovirus,respirat.
sincitial,,myxovirus,mycoplasma pneumoniae (ag.EATON),v.rujeolic,sincitial,,myxovirus,mycoplasma pneumoniae (ag.EATON),v.rujeolic,
bacil pertusis (tuse convulsiva),Ricketsia Burnetti,ornitoza,psittacoza…bacil pertusis (tuse convulsiva),Ricketsia Burnetti,ornitoza,psittacoza…
Aspecte RxAspecte Rx::
--infiltrat hiliobazal:infiltrat hiliobazal: gripal Dittmar/Rupert gripal Dittmar/Rupert
- ”aripi fluture”perihilar;- ”aripi fluture”perihilar;
- reticulogranitat, noduli miliari acinari(ateleczii acinare);- reticulogranitat, noduli miliari acinari(ateleczii acinare);
- reactii pleurale discrete- reactii pleurale discrete
ComplicatiiComplicatii:-:-bronhopneumonie,pneumonie,pleurezii bronhopneumonie,pneumonie,pleurezii mici.mici.
PNEUMONIE INTERSTITIALA:GRIPAPNEUMONIE INTERSTITIALA:GRIPAPNEUMONIE INTERSTITIALA:GRIPAPNEUMONIE INTERSTITIALA:GRIPA
TRIUNGHIUL DITTMAR & RUPPERTTRIUNGHIUL DITTMAR & RUPPERT
EtiologieEtiologie::
Bacil Koch (BK);cale contaminare:aeriana(Flüge)Bacil Koch (BK);cale contaminare:aeriana(Flüge)
CLASIFICARE:CLASIFICARE:
II.-.-Tuberculoza primara(primo infectia);Tuberculoza primara(primo infectia);
II.-Tuberculoza secundara (ftizia)II.-Tuberculoza secundara (ftizia)
Tuberculoza primară
complexul primar◦ afectul primar◦ limfangita tuberculoasă ◦ adenopatia satelită
adenopatie hilară pleurezie serofibrinoasă unilaterală tuberculoza primară miliară
COMPLEX PRIMAR TUBERCULOSCOMPLEX PRIMAR TUBERCULOS
AFECTAFECT
LIMFANGITALIMFANGITA
ADENITAADENITA
RANCKERANCKE
COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: periadenita periadenita
COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: periadenita periadenita
COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: diseminarea hematogena= miliara tbcdiseminarea hematogena= miliara tbc
COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: diseminarea hematogena= miliara tbcdiseminarea hematogena= miliara tbc
ADENITAADENITA
ADENITAADENITA
COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: pneumonia cazeoasa
COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: pneumonia cazeoasa
1) Noduli fibrosi apico-subclaviculari1) Noduli fibrosi apico-subclaviculari
2) Infiltratul precoce subclavicular2) Infiltratul precoce subclavicular
3) CAVERNA
• recenta
• elastica
• scleroasa
NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI !! !!NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI !! !!
Infiltrat Infiltrat precoceprecoce
gglggl
INFILTRAT PRECOCE TBC==>INFILTRAT PRECOCE TBC==>
==> DEBUTUL FTIZIEI…..==> DEBUTUL FTIZIEI…..
INFILTRAT PRECOCE TBC==>INFILTRAT PRECOCE TBC==>
==> DEBUTUL FTIZIEI…..==> DEBUTUL FTIZIEI…..
coadacoada
paleta
““racheta de tenis”racheta de tenis”
Infiltrat in curs deInfiltrat in curs de excavareexcavare
Zile..saptaminiZile..saptamini
TUBERCULOM APICALTUBERCULOM APICALTUBERCULOM APICALTUBERCULOM APICAL
Tomografie planaTomografie planaTomografie planaTomografie plana
DEBUT AL FTIZIEI ADULTULUI=CAVERNA..DEBUT AL FTIZIEI ADULTULUI=CAVERNA..DEBUT AL FTIZIEI ADULTULUI=CAVERNA..DEBUT AL FTIZIEI ADULTULUI=CAVERNA..
TUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATomografie planaTomografie plana
TBC CAZEOASA -CAVITARATBC CAZEOASA -CAVITARA
TUBERCULOMULTUBERCULOMUL
TBC FIBROASATBC FIBROASA
TBC HIPERCRONICA TBC HIPERCRONICA
COMPLICATII/SECHELE COMPLICATII/SECHELE
- HEMOPTIZIA;- HEMOPTIZIA;
- FIBROTORAX;- FIBROTORAX;
- CORD PULMONAR CRONIC;- CORD PULMONAR CRONIC;
- AMILOIDOZA etc.- AMILOIDOZA etc.
FTIZIE: CAVERNA GIGANTAFTIZIE: CAVERNA GIGANTAFTIZIE: CAVERNA GIGANTAFTIZIE: CAVERNA GIGANTA
Diseminare controlaterala
TUBERCULOZA EXTENSIVA CAZEOASA TUBERCULOZA EXTENSIVA CAZEOASA
-Sisteme de caverne-Sisteme de caverne
-pneumonie cazeoasa lob inf.-pneumonie cazeoasa lob inf.
TUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARA
Caverne+infiltrate+fibrozaCaverne+infiltrate+fibroza
Tomografie planaTomografie planaTomografie planaTomografie plana
FTIZIE; PNEUMONIE CAZEOASA CAVITARAFTIZIE; PNEUMONIE CAZEOASA CAVITARAFTIZIE; PNEUMONIE CAZEOASA CAVITARAFTIZIE; PNEUMONIE CAZEOASA CAVITARA
FTIZIE:DISEMINARE BRONHOPNEUMONICAFTIZIE:DISEMINARE BRONHOPNEUMONICA
FTIZIEFTIZIE:DISEMINARE MILIARA IN:DISEMINARE MILIARA IN
TUBERCULOZA SECUNDARA TUBERCULOZA SECUNDARA
FTIZIEFTIZIE:DISEMINARE MILIARA IN:DISEMINARE MILIARA IN
TUBERCULOZA SECUNDARA TUBERCULOZA SECUNDARA
Etiologie:Taenia equinococus
CHP NECOMPLICAT:CHP NECOMPLICAT:-macronodul opac gr.II-III;contur net-macronodul opac gr.II-III;contur net
(“tras cu compasul”),;”plasticitate” respiratorie;compresibil pe (“tras cu compasul”),;”plasticitate” respiratorie;compresibil pe plan dur(diafragm,coaste,cord).plan dur(diafragm,coaste,cord).
Dg.dif.=Dg.dif.=cancer periferic nodular. (CT,echografie).cancer periferic nodular. (CT,echografie).
CHP COMPLICAT:CHP COMPLICAT:--
a)a)Fisurat: Fisurat: comunicare bronsica=>semn MORQUIO (decolarea comunicare bronsica=>semn MORQUIO (decolarea membranelor, semiluna aerica);membranelor, semiluna aerica);
b)b)Rupt:Rupt:imag.hidro-aerica, nivel lichidian ondulat, membrane retinuteimag.hidro-aerica, nivel lichidian ondulat, membrane retinute
3)Diseminat:3)Diseminat:-hidatidoza secundara (macronoduli bilaterali)-hidatidoza secundara (macronoduli bilaterali)
CHIST HIDATIC NECOMPLICATCHIST HIDATIC NECOMPLICAT
Chist hidaticChist hidatic
complicat:complicat:
fisurareafisurarea
Chist hidaticChist hidatic
complicat:complicat:
fisurareafisurarea
SEMNUL SEMILUNEI AERICE
CHIST HIDATIC COMPLICAT:CHIST HIDATIC COMPLICAT:
RUPTURA CHISTULUIRUPTURA CHISTULUI
CHIST HIDATIC COMPLICAT:CHIST HIDATIC COMPLICAT:
RUPTURA CHISTULUIRUPTURA CHISTULUI
CHISTURICHISTURI
HIDATICEHIDATICE
MULTIPLEMULTIPLE
CHISTURICHISTURI
HIDATICEHIDATICE
MULTIPLEMULTIPLE
Cea mai frecventa localizare;locul 1 mortalitate..!! FUMATUL!!
Histopatologie:Histopatologie:-epitelial epidermoid(squamos);-epitelial epidermoid(squamos);
adenocarcinom; celule mici ; sarcom.adenocarcinom; celule mici ; sarcom.
Anatomo-radiologic:Anatomo-radiologic:-bronsii mari (central)-bronsii mari (central)
-bronsii mici (periferic)-bronsii mici (periferic)
-alveolar (rarissim).-alveolar (rarissim).
Sediul fata de lumenSediul fata de lumen:-endobronsic==>atelectazie;:-endobronsic==>atelectazie;
-exobronsic ===>”iceberg”-exobronsic ===>”iceberg”
1)1)EVIDENTIAZA TUMORAEVIDENTIAZA TUMORA:-Rx.standard,bronhografia,CT.:-Rx.standard,bronhografia,CT.
Aspecte: -Aspecte: -cancer hilar(central) cancer hilar(central) endobronsic=>atelectazieendobronsic=>atelectazie (segment,lob,pulmon);(segment,lob,pulmon); bronhografie: bronhografie: stenoze, amputatiistenoze, amputatii
-cancer hilar (central) exobronsic=>nodul -cancer hilar (central) exobronsic=>nodul opacopac
hilar + prelungiri radiare=“krebs füsse”(picioare hilar + prelungiri radiare=“krebs füsse”(picioare crab)crab) -cancer periferic,nodular=>nodul opac -cancer periferic,nodular=>nodul opac gr.II-gr.II-III, contur neregulat (prelungiri.),intensitate III, contur neregulat (prelungiri.),intensitate mare;mare;
Radiografie standardRadiografie standard
Tomografie planaTomografie plana
BronhografieBronhografie
CANCER BRONHO-PULMONAR LOB SUPERIOR DREPTCANCER BRONHO-PULMONAR LOB SUPERIOR DREPT
-tip endobronsic:obstructie bronsica si atelectazie secundara-tip endobronsic:obstructie bronsica si atelectazie secundara
CANCER ENDOBRONSICCANCER ENDOBRONSIC
Obstructia bronsiei primitive:ATELECTAZIE TOTALA Obstructia bronsiei primitive:ATELECTAZIE TOTALA
CANCER EXOBRONSIC-CANCER EXOBRONSIC-
““MASIV AL HILULUI”MASIV AL HILULUI”
“Krebs füsse”
CANCER NODULAR PERIFERICCANCER NODULAR PERIFERIC
CANCER CANCER
NODULARNODULAR
PERIFERICPERIFERIC
Computer tomografie:Computer tomografie:
A).fereastra pulmon;A).fereastra pulmon;
B).fereastra mediastinB).fereastra mediastin
AA
BB
2)2)APRECIAZA EXTENSIA LOCO-REGIONALAAPRECIAZA EXTENSIA LOCO-REGIONALA
Metode:Metode:--tomogr.US ,CT,cavografia,art.pulmonara,IRMN.tomogr.US ,CT,cavografia,art.pulmonara,IRMN.
Aspecte:Aspecte:-extensia mediastinala=>adenopatie,sten/tromb VCS;-extensia mediastinala=>adenopatie,sten/tromb VCS;
-extensia parietala=>apex=>Sd.Pancoast-Tobias;-extensia parietala=>apex=>Sd.Pancoast-Tobias;
-extensia lobara=>cancer lobar (“lobita carcinomat”)-extensia lobara=>cancer lobar (“lobita carcinomat”)
-invazie pericard=>pericardita=>-invazie pericard=>pericardita=>eco-cardiografia !eco-cardiografia !3)3)EVIDENTIAZA COMPLICATIILEEVIDENTIAZA COMPLICATIILE -necroza=>excavare=>suprainfectia;-necroza=>excavare=>suprainfectia; -invazia costala,pleurala-invazia costala,pleurala
4)4)DECELEAZA METASTAZELEDECELEAZA METASTAZELE
-OS=>scintigr.Tc99;CREIER=>IRMN,CT;FICAT,SR=>US-OS=>scintigr.Tc99;CREIER=>IRMN,CT;FICAT,SR=>US
CANCER EXTINS LOBARCANCER EXTINS LOBAR
CANCER BRONHO-PULMONAR:extensie parietalaCANCER BRONHO-PULMONAR:extensie parietala
Sd.PANCOAST-TOBIASSd.PANCOAST-TOBIAS
CANCER BRONHO-PULMONARCANCER BRONHO-PULMONAR
ApreciereaAprecierea
extensieiextensiei
mediastinalemediastinale
prin CTprin CT
CAI DE PROVENIENTA:CAI DE PROVENIENTA:
11))HEMATOGENAHEMATOGENA=> => noduli opaci gr.II-III, diseminatinoduli opaci gr.II-III, diseminati
anarhic, bilateral, inegali; nu conflueaza; contur net, forma anarhic, bilateral, inegali; nu conflueaza; contur net, forma rotunda (“lansare de baloane”..). rotunda (“lansare de baloane”..). Cauta: Cauta: cancercancerprimitiv teritoriul cav: san, testicul, rinichi, os, prostata.primitiv teritoriul cav: san, testicul, rinichi, os, prostata.
2)2)LIMFATICALIMFATICA=>=> diseminare peribonhovasculara/interstitiala diseminare peribonhovasculara/interstitiala parenchimatoasa: cordoane,micronoduli perihilar/hiliobazal parenchimatoasa: cordoane,micronoduli perihilar/hiliobazal bilat;asociaza pleurezie. bilat;asociaza pleurezie. CautaCauta:san:san, , pancreas, stomac, etc.pancreas, stomac, etc.3)3)MIXTA:-carcinomatoza “miliara”:MIXTA:-carcinomatoza “miliara”:-diseminare ininterstitiu, limfatic+hematogen: micronoduli diseminati pefond trabecular bilateral; tendinta la conglomerare.Cauta:Cauta:sin,tiroida,digestivsin,tiroida,digestivDg.difDg.dif.:bronhopneum.(1,3),hidatidoza(1),miliara tbc(3);.:bronhopneum.(1,3),hidatidoza(1),miliara tbc(3); -silicoza,viroze,colagenoze (2)-silicoza,viroze,colagenoze (2)
METASTAZE PULMONARE TIP HEMATOGENMETASTAZE PULMONARE TIP HEMATOGEN
METASTAZE PULMONARE TIP LIMFATICMETASTAZE PULMONARE TIP LIMFATIC
1)1)PLEUREZII:PLEUREZII:--TranssudatTranssudat=>insufic.cardiaca.=>insufic.cardiaca.
--ExsudatExsudat=>inflamator,neoplazii etc.=>inflamator,neoplazii etc.A. A. PLEUREZIA MARII CAVITATI (PLEUREZIA MARII CAVITATI (mica,medie,mare,masiva) mica,medie,mare,masiva) Rx.:Rx.:opacitate omogena decliva gravitational dependenta; opacitate omogena decliva gravitational dependenta;
curba curba DamoiseauDamoiseau.
B. B. PLEUREZII INCHISTATE (PLEUREZII INCHISTATE (scizurala orizontala,oblica) scizurala orizontala,oblica)
Rx: Rx: -opacitate ovoida, fuziforma;-opacitate ovoida, fuziforma;
- diafragmatica: ascensionare diafragm; - diafragmatica: ascensionare diafragm; - mediastinala:largire in banda, - mediastinala:largire in banda,
- axilara:banda opaca paralela cu peretele axilar;- axilara:banda opaca paralela cu peretele axilar;
C. C. SECHELE PLEURETICE=SECHELE PLEURETICE=PAHIPLEURITE:PAHIPLEURITE:
-fibroase,fibrocalcare=>placarde,”platosa”,”cuirasa”.-fibroase,fibrocalcare=>placarde,”platosa”,”cuirasa”.
Rx.: Rx.: opacitati in banda, calcif.amorfe, retractii costale,opacitati in banda, calcif.amorfe, retractii costale,
” ”corturi”diafragcorturi”diafrag matice, simfize/imobilizare diafragmatica, matice, simfize/imobilizare diafragmatica,
deviere mediastin, coloana vertebraladeviere mediastin, coloana vertebrala..
PLEUREZIA MARII CAVITATI:cantitate mica (A);PLEUREZIA MARII CAVITATI:cantitate mica (A);cantitate mare (B)cantitate mare (B)
PLEUREZIA MARII CAVITATI:cantitate mica (A);PLEUREZIA MARII CAVITATI:cantitate mica (A);cantitate mare (B)cantitate mare (B)
A B
PLEUREZIA MARII CAVITATIPLEUREZIA MARII CAVITATI
PLEUREZIIPLEUREZII
INCHISTATEINCHISTATE
INTERLOBARINTERLOBAR
PLEUREZII INCHISTATE DIAFRAGMATICPLEUREZII INCHISTATE DIAFRAGMATIC
PLEUREZIIPLEUREZII
INCHISTATE:INCHISTATE:
PLEUREZIAPLEUREZIA
MEDIASTINALAMEDIASTINALA
SECHELE POST-PLEUREZIESECHELE POST-PLEUREZIE
PAHIPLEURITA CALCARAPAHIPLEURITA CALCARA
2)2)PNEUMOTORAX PNEUMOTORAX TOTAL/PARTIAL TOTAL/PARTIAL
Etiologie: Etiologie: spontan (astm !), accidental (trauma), spontan (astm !), accidental (trauma), iatrogen=>Dg & terapeutic. iatrogen=>Dg & terapeutic.
Tipuri: Tipuri: --endogenendogen (bula emf.,caverna); (bula emf.,caverna); exogenexogen=> plaga, => plaga, fracturi costale; fracturi costale; iatrogen (iatrogen (acc.punctie,dg/terap).acc.punctie,dg/terap).
Tipuri anat/radiologice:Tipuri anat/radiologice:-in pleura libera=>colaps la hil;-in pleura libera=>colaps la hil;
-in pleura simfizata=>colaps limitat-in pleura simfizata=>colaps limitat
Dg.Rx:Dg.Rx:- hipertransparenta cu absenta desenului pulmonar;- hipertransparenta cu absenta desenului pulmonar;
-linia bordanta pleurala viscerala;-linia bordanta pleurala viscerala;
-bont pulmonar colabat la hil, opac;-bont pulmonar colabat la hil, opac;
COMPLICATII:COMPLICATII:-hidro-pneumotorax-hidro-pneumotorax
-pio/hemo-pneumotorax.-pio/hemo-pneumotorax.
PNEUMOTORAX HIDRO-PNEUMOTORAXPNEUMOTORAX HIDRO-PNEUMOTORAX
Histopatologie:Histopatologie:-Endo/mezoteliom;sarcom;metastaze.-Endo/mezoteliom;sarcom;metastaze.
SEMNE RADIOLOGICESEMNE RADIOLOGICE :-noduli opaci marginali + :-noduli opaci marginali +
-epansament pleural variabil,-epansament pleural variabil,
hemoragic;hemoragic;
Dg.dificil CT;ecografie;PLEUROSCOPIE & biopsie;Dg.dificil CT;ecografie;PLEUROSCOPIE & biopsie;
PUNCTIE-BIOPSIE ghidata imagisticPUNCTIE-BIOPSIE ghidata imagistic
TUMORA PLEURALA:MEZOTELIOMTUMORA PLEURALA:MEZOTELIOM
C O R D U L SI VASELE MARI
NEINVAZIVE
•US+Doppler color: duplex, triplex mod;”stress-Echo software”;
•RADIOGRAFIA standard => teleradio./fluoroscopie
• ANGIOCORONAROGRAFIE CT
•IRMN=>>cine,”Real time”; incidente multiple,reconstructii 3D;
•SCINTIGRAFIE
INVAZIVE
•CATETERISM + ANGIOGRAFIE+ OXIMETRIE+ PRESIUNI•angiocardiografie globala; levo-cardiograma(VStg);
•coronarografie selectiva;
•Digital Subtraction Angiography(DSA).
MODIFICARI VOLUMETRICE1)HIPERTROFIA ATRIU STING: fluoroOAD+BariuEsofag
•Rg.PA=>contur concentric dublu,”festonat”,inversat;
bifurcatie traheala prin ascensiunea bronsiei pr.stg.;
•golful pulmonarei=rectiliniu sau convex.
2)HIPERTROFIA VENTR.STG:fluoro.OAS+Ba-Esofag;
•Radiografie PA=> longitudinal & transversal;
•alungire/rotunjire arc inferior stg.;infundare in diafragm;
•Radiogr.OAS-arc inferior-posterior X coloana vertebrala..
CORD MITRAL:ATRIUL STING ,VIZIBIL MARIT
ASASASAS
CORD AORTIC:MARIRE A VENTRICULULUI STING
SI ECTAZIE AORTICA IN INSUFICIENTA AORTICA
PA OAS
MODIFICARI VOLUMETRICE
3)HIPERTROFIA DE ATRIU DREPT(AD)
•Rg.PA=>marire/bombare arc inferior drept=>=>dreapta;
•Rg.OAD=>bombare arc inf/posterior(pe diafragm);amprenta pe esofag baritat,inferior;obturare spatiu clar retrocardiac.
3)HIPERTROFIA DE VENTRICUL DREPT(VD).
•Rg.PA=> transversal;bombeaza arc inf.stg.;ridica vf.cord= “cord in sabot”;bombeaza arc inf .dr.:”impinge “AD;golf pulm. convex;
•Rg.OAD/OAS=>infundibul Art.Pulm. marit;obturare sp.clar retrosternal
MODIFICARI VOLUMETRICE
5)HIPERTROFIA GLOBALA
a)Cardiomegalia:arcuri & unghiuri cardiofrenice pastrate; volum global marit;pulmon cardiac;
b)Pericardita:unghiuri cardiofrenice sterse,obtuze,arcuri disparute;pulmon: NORMAL sau staza venoasa (tamponada)
fluoroscopic:pulsatii atenuate/disparute;dg.dif.:ECOGRAFIC
CALCIFICARI CARDIACE
1)ORIFICIALE:-fluoro:Ao= misc oblice;Mitrala=misc oriz.
-Pozitia in incid.lat:aortice=sup/post;mitrale=inferior/ant.
2)AORTICE PARIETALE:ateromatoza,anevrisme;
3)PERICARDICE-pericardita calcara;
4)MIOCARDICE:-infarct;anevrism;mixom;
5)CORONARIENE:ateromatoza;
OPACITATI ARTIFICIALEProteze valvulare metalice;proteze vasculare endoluminale
metalice(coronare);sonde stimulare intracardiaca/pacemaker
OPACITATI METALICE “IATROGENE”
Proteza valvularaProteza valvulara PacemakerPacemaker
I.STENOZA MITRALA
II.INSUFICIENTA MITRALA
IV.STENOZA AORTICA
V.INSUFICIENTA AORTICA
Rx.=>CORD MITRAL: AS ;
BaEsof.OAD;
golf AP convex;
VS;
buton aortic ;
=>PULMON:-vene dilatate=>staza=> rezist.perif.=>
-spasm capilar(baraj II)=>hipertr.V.Dr.
CORD MITRAL:ATRIUL STING ,VIZIBILMARIT
HEMODINAMICA:reflux sistolic VS=>AS(“sînge pendulant”)=> hipertrofie VS+AS=>stază pulmonara=>Hipertrofie VDr.
Rx: volum AS;
volum VS;
expansiune sistolica AS= regurgitarea sistolica a Bariului in esofag (OAD);
CATETERISM VS & LEVOCARDIOGRAMA:-injectia in VS opacifiaza sincron aorta si prin contrast refluat- AS.
CORD MITRAL-”BOVIN”:BOALA MITRALA
VALVULOPATIE MITRALA (BOALA) DECOMPENSATA
EDEM PULMONARLinii KERLEY B
Clasificare;subvalvulara,valvulara,supravalvulara(coarctatia)
Hemodinamic:baraj vidare sistolica a VS=> VS;efect “jet”
post-stenotic (COANDĂ)=>ectazie fuziforma AO ascendenta
Rx: - hipertrofie VS;
- AO asc.ectaziata/buton AO sters
-± calcificari valvulare;
CATETERISM:-dificil (stenoza);gradient presional VS/AO.
MORFOLOGIC: valve béante, incongruente, inel larg;
HEMODINAMIC: -singe regurgitat AO=>VS(pendulant);insuf. Mitrala functionala prin marirea VS (tardiv)
Rx:- marire VS;
- AO amplu pulsatila,ectaziata,batanta;
-golf adincit=>”cord aortic”;
CATETERISM aortic & angio: -injectia in AO supravalvular arata “caderea” contrastului, in diastola ventriculara, in VS.
CORD TIP AORTIC:INSUFICIENTA AORTICA
VSVSVS
OASOASPAPA
INSUFICIENTA AORTICA ATEROMATOASA
RAD.STANDARD ANGIO-RMNANGIO-RMN
PERICARDITE LICHIDIENE:
-EXSUDATIVE:-virale,tbc,reumatice;
-TRANSSUDATIVE:-neoplazica,uremica etc.
SEMNE Rx:
-stergerea sin.cardiofrenice;
-cord mare,”linistit”,pulsatii reduse;
-forma triunghiulara;
-arcuri sterse;
-migrare a lichidului spre mediastin =>decubit;
-scurtarea pediculului vascular al siluetei cardio-vasc;
-aspect “in carafa”;
-plamin normal sau stazic (in valvulopatii)
PERICARDITA EXSUDATIVA PE CORD PATOLOGIC
PERICARDITA EXSUDATIVA: A)ortostatism;B)decubit
AA BB
PNEUMOPERICARD
Sinonim=PERICARDITE FIBROASE
CONCRETIO CORDIS: simfiza pericardica intre foitele int/ext.;
APECT Rx: -pericardul ingrosat se calcifica(“pericardita calcara)
si se produc imagini “in dale de pavaj”,”in zale”(cuirasa=“panzer
herz”), arciforme -”in coaja de ou”.Dg.facil rad.in incid.oblice,lat.
ACRETIO CORDIS:simfiza pleuro-pericardica.
ASPECT Rx: -cordul poate avea dimensiuni normale, dar contur
modificat: dintat,festonat,”in corturi” pleuropericardice, stergere a sin.cardiofrenice; cord “fixat” la stern:in sistola, stern tras la cord;in inspir -peretele toracic tras spre placardul pericardic=>semnul WENKEBACH.
PERICARDITA CONSTRICTIVA FIBRO-CALCARA
PERICARDITA CONSTRICTIVA FIBRO-CALCARA
CONCRETIO & ACRETIO CORDISCONCRETIO & ACRETIO CORDIS
top related