lp 2-2radio.pptx

7/25/2019 LP 2-2RADIO.pptx

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PATOLOGIA INFECTIOASA A

APARATULUI RESPIRATOR

DR. SPIRIDON ELENA


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Etiologie: bacterii, virusuri, fungi

Clasifcare: Pneumonii bacteriene nesupurate: Pneumonia lobara franca Bronhopneumonia

Pneumonii bacteriene supurate: Abcesul pulmonar

Gangrena pulmonara Supuratii pulmonare difuze

Pneumonii interstitiale


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Pneuonia !acteriana"#ranca lo!ara$

Etiologie: Streptococcus pneumoniae (90!

As%ect ra&iologic: sindrom de umplere alveolara

evolutie in concordanta cu stadiile anatomo"patologice

De!ut: #$h % faza de congestie alveolara si e&udatie

aspect normal'direct aspectul din faza de stare

Perioa&a &e stare: #" zile % alveolele ocupate de e&udat sero)brinos cu numeroase leucocite

*pacitate triunghilara, cu varful la hil si baza la periferie, fara modi)careadimensiunii teritoriului pulmonar respectiv, limita spre scizura neta si sprecelelalte segmente imprecisa, intensitatate medie, omogena, cubronhograma aerica prezenta

Perioa&a &e resor!tie

+"9 zile de la debut'#"-h de la initierea antibioterapiei .ntensitatea opacitatii incepe sa scada, apare alveolograma aerica


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'o&alitati &e resor!tie:

omogena"scaderea intensitatii pe toatasuprafata/e la periferie spre centru ( )g1!/e la centru spre periferie ( )g/!

.n tabla de sah ()g2!


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Pneuonie L'D


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Pneuonie LSD


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Co%licatii: Abcesul pulmonar

Pleureziile para si metapneumonica

3ezolutia intarziata %varstnici, malnutritie,alcoolism

Pericardita purulenta % f rara

2ndocardita pneumococica % la bolnavi valvulari 4eningita pneumococica " rar, diseminare

hematogena

Glomerulonefrita pneumococica " mecanism

imunologic .nsu)cienta cardiaca acuta" varstnici


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Agenti etiologici: micoplasme, virusuri (respirator sincitial, gripal, paragripal,ru5eolei, varicelei!, ric6etsii

Anatoo(%atologic: in)ltrarea interstitiului peribronho"alveolar cu monocite,plasmocite, histiocite

As%ect ra&iologic:"desen pulmonar perihilar accentuat" uni sau bilateral" desen reticular )n, apoitrabecule opace groase, estompate

"opacitatile liniare formeaza un triunghi hilio"bazal care se desface in evantai ininspir profund (triunghiul gripal!

"opacitati miliare, micronodulare cu aspect bronho"pneumonic (plurifocale, cucontur imprecis!

"opacitatile nodulare se pot e&tinde la un segment

"aspect in sticla mata

E)olutie"7indecare fara sechele % imaginea radiologica dispare in - saptamani

"Pot persista noduli calci)cati % in varicela (calci)carea zonelor de necrozabronsiolara!

Co%licatii:

Pneuonia interstitiala


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.n)ltrat reticulo"nodular cu distributie bronho"vasculara bazal

drept (pneumonie cu adenovirus!


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*RON+OPNEU'ONIADEF: Pneumonia in focare multiple, care pot ) in stadii diferite de

evolutie

Agenti etiologici : sta)lococul, streptococul, 6lebsiela ,pneumococul

Afecteaza copii, batrani, persoane tarateContainare % inhalatorie' hematogena (septicemii!

As%ect ra&iologic: /2B" accent desen bronhovascular hilar si parahilar P23 /2 SA32 " noduli de diferite dimensiuni("0 mm!,de

intensitate medie, diseminati bilateral, asimetric, contur ;u (e&udatalveolar! si centru opac (bronsiola cu e&udat mucos, puroi!, tendinta

la con;uare " asincronism evolutiv (focarele bronsiolo"alveolare pot ) in faze de

evolutie diferite!

DD: uberculoza miliara (noduli diseminati uniform!, 4iliaracarcinomatoasa , 4etastaze pulmonare hematogene (contur net, nucon;ueaza!, Pneumonia lobara, .nfarct pulmonar


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Bronhopneumonia miliara

Multiple opacitati,

dimensiuni mici,

intensit. medie,

diseminati in

ambele arii

pulmonare,

predominant

parahilar si bazal.


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Bronhopneumonia macronodulara

Opacitati

nodulare,

localizate in

ambele ariipulmonare

(perihilar si

inferior), de

intensitate medie,

contur imprecis,

centru opac si cu

tendinta la

confluare.


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Bronhopneumonia forma pseudolobara

Opacitati

confluante


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Bronhopneumonia stafilococica

Sugari, copii.

Opacitati nodulare cu

tendinta la confluare, ce

evolueaza rapid spre

abcedaresi formare de

pneumatocele.

Caracteristica

variabilitatea imaginii

radiologice de la o zi la

alta.

Complicatii

piopneumotora!.


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AB12S< P


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Abcese multiplecomplicate

(post"vomica!localizate in focar

pneumonic


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Abces complicat

(post"vomica!recent" peretegros


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Abcese in diferitestadii evolutive:

necomplicate,post"vomica vechi

(nivel orizontal,

perete subtire!

C li tii b ltil l


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Co%licatii: " abces multilocular8

"gangrena pulmonara (focare de necroza septica, difuze, cu multipleimagini cavitare ce pot con;ua!

DD: 1> infectat, chist aerian infectat, 1BP supurat si abcedat,

caverna B, aspergiloza, chist bronhogen infectat


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C+ISTUL +IDATIC

aenia echinococcus"intestin embrion he&acant"sist port )cat"venele suprahepatice" cord dreapt"pl?m@n

C+ISTUL +IDATIC -NC+ISNECO'PLICAT opacitate ovalar/rotund

bine conturat?, contur tras cu compasul, aspect mai estompatdatorit? atelectaziei perichistice sau aspect n tre;?, n bisacdatorit? deform?rii din cauza obstacolelor anatomice


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1>necomplicat


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1> )surat

1> rupt


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>./A./*DA


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Diagnosticul &i#erential al iaginilor/i&roaerice

A. Iagini /i&ro(aerice %riare:

&. &magini hidro-aerice prin procese patologiceparenchimatoase,

cavern? B1 dup? eliminare parEial?8cancer pulmonar infectat si e&cavat8

chist hidatic pulmonar dup? vomic?8

atelectazie pulmonar? infectat? i e&cavat?

micoz? pulmonar? supra"infectat? i e&cavat?8

pl?m@n polichistic supra"infectat8

chist aerian infectat8

infarct pulmonar e&cavat8


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&&. &magini hidro-aerice prin procese patologice ronice,

broniectazii nespeci)ce infectate8

broniectazii speci)ce8

&&&. &magini hidro-aerice prin procese patologicepleurale,

;uido"pneumo"toracele (hidro'pio'hemo!

colecEii hidroaerice nchistate n scizuri i n mareacavitate8

&". &magini hidro-aerice prin procese patologicedigestive,

hernii hiatale8 hernia intratoracic? de colon8diverticul esofagian de pulsiune descins n mediastin8

megadolicoesofag

*.Iagini /i&ro(aerice secun&are :


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1-"F coarctatie ao ani


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Anevrism fuziform ao(arc! +cm vecin cu a sc stg


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1rohn disease Spot vie of theterminal ileum from a small"boel

follo"through studH demonstratesseveral narroing and stricturing,consistent ith the string sign Alsonote a sinus tract originating from themedial all of the terminal ileum andthe involvement of the medial all ofthe cecum


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1rohn disease Sonogram of athic6ened boel all demonstratesthe so"called pseudo6idneHappearance

1rohn disease 1obblestoning Spotvie of the terminal ileum from asmall"boel follo"through studHdemonstrates linear longitudinal andtransverse ulcerations that create acobblestone appearance Also notethe relativelH greater involvement ofthe mesenteric side of the terminalileum and the displacement of theinvolved loop aaH from the normalsmall boel secondarH to mesentericin;ammation and )brofattH


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Anevrism fuziform ao(arc! +cm vecin cu a sc stg


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1rohn disease Active small"boelin;ammation 1 scan demonstratessmall"boel all thic6ening,mesenteric in;ammatorH stranding,

and mesenteric adenopathH

1rohn disease 4esentericin;ammation 1 scan demonstratesan in;ammatorH mass in the rightloer Iuadrant associated iththic6ening of the all and narroingof the lumen of the terminal ileum


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43. enterographH -"dimensionalgradient postcontrast seriesdemonstrates strati)edhHperenhancement of the mucosa ofthe distal ileum in a patient ithactive 1rohn disease


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43. enterographH, steadH"state free"procession image, demonstratesvascular engorgement of the vasarecta or JcombJ sign in a thic6enedileum boel loop during activedisease


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43. enterographH ith coronal fat"saturated #"eighted single"shotfast spin echo imaging demonstratesmesenteric edema and mural alledema and thic6ening in a patient

ith active 1rohn disease in the distal


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.= P2322


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321 B AB12S 1*= C.S


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13*>= C.S


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C.S

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