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Investigatii paraclinice de diagnostic

Imagistica

Radiologia clasica

CT

RMN

Examenul ultrasonografic

Scintigrama de ventilatie/perfuzie

- PET

- Angiografia

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CT

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RMN

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PET

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Scintigrama V/Q

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Investigatii paraclinice de diagnostic

Bronhoscopia

Patologie endobronsica

Biopsie broonsica si transbronsica

Lavaj bronhoalveolar (bronsie subsegmentara)

Terapeutica (corpi straini,aspirarea

secretiilor,hemoptizia)

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Investigatii pentru diagnosticul

morfologic

Examen citologic

Sputa

Aspirat si lavaj bronsic

Lavaj bronhoalveolar

Ex lichidului pleural

Examen histopatologic

Biopsia bronsica sau transbronsica

Biopsia percutana cu ac fin

Biopsia prin mediastinoscopie

Biopsia pulmonara (toracotomie)

Biopsia pleurala

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Lavaj bronhoalveolar

Modificari pulmonare interstitiale sau infiltrate nesistematizate

Particole de pulberi in macrofage pneumoconioze

Fragmente de eritrocite

sd de hemoragie intraalveolara

Infectii cu germeni oportunisti

Cel tumorale cancer pulmonar, limfoame

Limfocitoza cu raport CD4/CD8, eozinofilie

Colagenoze, limfoame

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Evaluarea ventilatiei

Volume, capacitati

Complianta pulmonara (statica)

Crescuta emfizem

Scazuta

fibroza interstitiala

perete toracic (cifoscolioza, obezitate)

Forta musculaturii respiratorii

Presiunea maxima inspiratorie/expiratorie

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Volume si capacitati

Evaluarea ventilatiei

Probe ventilatorii (Conditii dinamice = Spirometrie)

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VEMS (valoare absoluta) sau VEMS/CV (%)

Debit maximal la mijlocul expiratiei (Forced midexpiratory flow rate)

VEMS scazut (valoare absoluta) sau VEMS/CV (%)Curba aplatizataDurata expirului mai mareVolumele/capacitatea pulmonare crescute

CV si CVF scazute ; VEMS/CV (%)Volumele/capacitatile pulmonare scazute

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Normal

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Restrictie

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Obstructie

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Obstructie

VEMS/CVF scazut

Volumele pulmonare

crescute (VR, CRF, CPT)

Restrictie

CV scazuta

VEMS/CVF normal

Volumele pulmonare

scazute

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Factorul de transfer gazosCapacitatea de difuziune a CO (DLCO)

DLCO = Aria (membr. alv.-capilare) X Pco / Grosimea ( membr. alv.-capilare)

DLCO scazut

-emfizem,

- boli restrictive,

- pneumectomie

- HTAP

- anemie

DLCO crescut - policitemie, efort, sunturi stanga-dreapta, obezitate