radio imag.pulm 2
TRANSCRIPT
Patologie Patologie bronsicabronsica
DISPLAZII CHISTICEDISPLAZII CHISTICE
B.P.O.C.B.P.O.C.
BRONSIECTAZIIBRONSIECTAZII
BRONHOCELBRONHOCEL
MUCOVISCIDOZAMUCOVISCIDOZA
CORPI STRAINI TRAHEO-BRONSICICORPI STRAINI TRAHEO-BRONSICI
CANCER BRONHO-PULMONARCANCER BRONHO-PULMONAR
Displazii Displazii chisticechistice
Definitie: Definitie: malformatii congenitale ale mugurelui bronsic malformatii congenitale ale mugurelui bronsic terminal (bronsiolar). terminal (bronsiolar).
CHISTUL SOLITARCHISTUL SOLITAR
BOALA POLICHISTICA PULMONARA: cu localizare BOALA POLICHISTICA PULMONARA: cu localizare segmentara, lobara, pulmonara segmentara, lobara, pulmonara
Descriere radiologicaDescriere radiologica: - : - hipertransparenta;hipertransparenta;
- perete fin;- perete fin;
- elemente anatomice vecine => - elemente anatomice vecine => schelet, mediastin (in plamin schelet, mediastin (in plamin
polichistic) polichistic)
Definitie: Definitie: malformatii congenitale ale mugurelui bronsic malformatii congenitale ale mugurelui bronsic terminal (bronsiolar). terminal (bronsiolar).
CHISTUL SOLITARCHISTUL SOLITAR
BOALA POLICHISTICA PULMONARA: cu localizare BOALA POLICHISTICA PULMONARA: cu localizare segmentara, lobara, pulmonara segmentara, lobara, pulmonara
Descriere radiologicaDescriere radiologica: - : - hipertransparenta;hipertransparenta;
- perete fin;- perete fin;
- elemente anatomice vecine => - elemente anatomice vecine => schelet, mediastin (in plamin schelet, mediastin (in plamin
polichistic) polichistic)
Pulmon : patologie bronsica
CHISTURI AERIENE :tipul SOLITARCHISTURI AERIENE :tipul SOLITAR
Patologie bronsica
Tomografii planeTomografii plane
Rad/Imag-Iasi-2003
CHISTURI AERIENECHISTURI AERIENE
MULTIPLEMULTIPLE
Plamin polichisticPlamin polichisticBoala segmentaraBoala segmentara
Displazie congenitala
B.P.O.C.B.P.O.C.1 1 BRONSITA CRONICABRONSITA CRONICA:: Rx. standard: - desen pulmonar hilio-bazal intarit;Rx. standard: - desen pulmonar hilio-bazal intarit;
Bronhografie: - ”arbore mort”; dilatatii cilindrice;Bronhografie: - ”arbore mort”; dilatatii cilindrice;
- decalibrari bronsice;- decalibrari bronsice;
- ulceratii ale glandelor bronsice=>nise, - ulceratii ale glandelor bronsice=>nise,
””spiculi”spiculi”2 2 EMFIZEM PULMONAR:EMFIZEM PULMONAR: Distensie;- hipertransparenta (ruptura pereti alveolari siDistensie;- hipertransparenta (ruptura pereti alveolari sidistrugerea patului capilar).distrugerea patului capilar).
= Afectarea bronsiilor mici
3 3 ASTM BRONSIC INTRICAT ( CRONIC INFECTIOSASTM BRONSIC INTRICAT ( CRONIC INFECTIOS):): Inflamatie parietala; dopuri de mucus; bule de emfizem;Inflamatie parietala; dopuri de mucus; bule de emfizem; adesea combinatie cu 1 si 2.adesea combinatie cu 1 si 2.
BRONSITA DEFORMANTABRONSITA DEFORMANTA
Patologie bronsicaPatologie bronsicaULCERATII
“NISE” PARIETALE
BRONSIECTAZIIBRONSIECTAZII = dilatatii bronsice= dilatatii bronsice
A A CONGENITALECONGENITALE::- sindroame malformative complexe:- sindroame malformative complexe:
Sdr. KARTAGENER:- situs inversus, etmoido-antrita (surditate)
- bronsiectazii chistice Sdr. MUNIER - KÜHN:- idem, fara situs inversusB B DOBINDITEDOBINDITE: - secundare altor afectiuni: - secundare altor afectiuni
( (tractiuni parietale externetractiuni parietale externe))Rx.standard:--dilatatii bronsice pline - dilatatii bronsice pline - ”ciorchine”,cordoane”ciorchine”,cordoane -- dilatatii bronsice goale - dilatatii bronsice goale - rozeta Ameuille, fagure, lemnrozeta Ameuille, fagure, lemn mîncat de carii, mîncat de carii, - - bronsiectatic hilio-bazal bronsiectatic hilio-bazalBronhografia:--dilatatii cilindrice, chistice, dilatatii cilindrice, chistice, ampulare, sacciforme, moniliformeampulare, sacciforme, moniliforme
BRONSIECTAZIE BILATERALA: suprainfectie BRONSIECTAZIE BILATERALA: suprainfectie
Triunghiul bronsiectaticTriunghiul bronsiectatic
BRONSIECTAZIE:BRONSIECTAZIE:bronhografie:tipuri anatomo-radiologicebronhografie:tipuri anatomo-radiologice
BRONHOCEL BRONHOCEL == bronsie dilatata solitar, stenoza bronsie dilatata solitar, stenoza inflamatorie cu inchidere in amonte; mucus.inflamatorie cu inchidere in amonte; mucus.
RxRx. - nodul opac omogen parahilar.. - nodul opac omogen parahilar.
Dg.diferential: chist hidatic, adenopatie, cancer nodular Dg.diferential: chist hidatic, adenopatie, cancer nodular ( CT)( CT)
MUCOVISCIDOZAMUCOVISCIDOZA = tulburare genetica a secretiei de mucus = tulburare genetica a secretiei de mucus cu cresterea viscozitatii; staza; infectie; bronhocele multiple; cu cresterea viscozitatii; staza; infectie; bronhocele multiple; fibroza secundara; cord pulmonar cronic fibroza secundara; cord pulmonar cronic
( dg.dificil la nou nascut, copil)( dg.dificil la nou nascut, copil)
CORPI STRAINI TRAHEO-BRONSICICORPI STRAINI TRAHEO-BRONSICI
--opaci, transparenti; exogeni, endogeni;opaci, transparenti; exogeni, endogeni;
Rx: Rx: - - emfizem obstructiv localizat cu ventil expiratoremfizem obstructiv localizat cu ventil expirator
- atelectazie- atelectazie
Complicatii:Complicatii:- stenoza bronsica, infectie, bronsiectazii, perforatii,- stenoza bronsica, infectie, bronsiectazii, perforatii,
mediastinita, hemoptizii ( unele secundare mediastinita, hemoptizii ( unele secundare extractiei endoscopice)extractiei endoscopice)
tomografie plana (A) si Computer tomografie (B) tomografie plana (A) si Computer tomografie (B)
AA
BB
BRONHOCEL:BRONHOCEL:
CANCER BRONHO-CANCER BRONHO-PULMONARPULMONAR
Cea mai frecventa localizare neoplazica
FUMATUL
Histopatologie:Histopatologie: - carcinom epidermoid (squamos);- carcinom epidermoid (squamos);
adenocarcinom; celula mica (“oat cells”); sarcom.adenocarcinom; celula mica (“oat cells”); sarcom.
Anatomo-radiologic: Anatomo-radiologic: - bronsii mari- bronsii mari (central) (central)
- bronsii mici - bronsii mici (periferic)(periferic)
- alveolar (rarissim).- alveolar (rarissim).
Sediul fata de lumenSediul fata de lumen: : - endobronsic - atelectazie;- endobronsic - atelectazie;
- exobronsic - ”iceberg”- exobronsic - ”iceberg”
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
BRONHOGRAFIE(A)+TOMOGRAFIE(B)BRONHOGRAFIE(A)+TOMOGRAFIE(B)
A B
CANCER BRONHO-PULMONAR DR.
Tip endobronsic infiltrativTOMOGRAFIE PLANATOMOGRAFIE PLANA
Atelectazie in pleura liberaAtelectazie in pleura libera
CANCER ENDOBRONSICCANCER ENDOBRONSIC
Obstructia bronsiei primitive: ATELECTAZIE TOTALA Obstructia bronsiei primitive: ATELECTAZIE TOTALA
CANCER CANCER
NODULARNODULAR
PERIFERICPERIFERIC
Computer tomografie:Computer tomografie:
A fereastra pulmon;A fereastra pulmon;
B fereastra mediastinB fereastra mediastin
AA
BB
ROLUL IMAGISTICIIROLUL IMAGISTICII 1 1 EVIDENTIAZA TUMORAEVIDENTIAZA TUMORA:- :-
Metode: Rx.standard, CT, IRM, bronhografiaMetode: Rx.standard, CT, IRM, bronhografia
AspecteAspecte::- - cancer hilar(central) endobronsic - cancer hilar(central) endobronsic - emfizem emfizem
sistematizat sistematizat ((rarrar);); atelectazie atelectazie (segment,lob,pulmon);(segment,lob,pulmon);
bronhografiebronhografie: : stenoza - amputatie bronsicastenoza - amputatie bronsica dg.diferential: dg.diferential: pneumonie;pneumonie;
- - cancer hilar (central) exobronsic - cancer hilar (central) exobronsic - nodul opacnodul opac
hilar + prelungiri radiare = hilar + prelungiri radiare = “krebs “krebs füsse”(picioare crab)füsse”(picioare crab)
dg.diferential: adenopatie, anevrism artera pulmonaradg.diferential: adenopatie, anevrism artera pulmonara;; --cancer periferic, nodular - cancer periferic, nodular - nodul opac gr.II- III,nodul opac gr.II- III, contur neregulat (prelungiri) , contur neregulat (prelungiri) , intensitate mare.intensitate mare.
dg.diferential: chist hidatic, tuberculom, hamartomdg.diferential: chist hidatic, tuberculom, hamartom..
ROLUL IMAGISTICIIROLUL IMAGISTICII
2 2 APRECIAZA EXTENZIA LOCO-REGIONALAAPRECIAZA EXTENZIA LOCO-REGIONALA
Metode:Metode:- - CT, IRM, cavografia,angio pulmonara, US.CT, IRM, cavografia,angio pulmonara, US.
Aspecte:Aspecte:- extenzia mediastinala - - extenzia mediastinala - adenopatie, stenoza,adenopatie, stenoza,
tromboza VCS;tromboza VCS;
- extenzia parietala - apex - - extenzia parietala - apex - Sdr. Pancoast-Tobias;Sdr. Pancoast-Tobias;
- extenzia lobara - cancer lobar - extenzia lobara - cancer lobar (“lobita canceroasa”)(“lobita canceroasa”)
- invazie pericard - pericardita - - invazie pericard - pericardita - ecocardiografiaecocardiografia
3 3 EVIDENTIAZA COMPLICATIILEEVIDENTIAZA COMPLICATIILE - necroza - excavare - suprainfectia;- necroza - excavare - suprainfectia; -invazia costala, pleurala-invazia costala, pleurala4 4 DECELEAZA METASTAZELEDECELEAZA METASTAZELE
OS - OS - scintigr.Tc99; scintigr.Tc99; CREER - CREER - IRM,CT; IRM,CT; FICAT,SR - FICAT,SR - USUS
Sindrom Pancoast - Tobias
Cancer bronhopulmonar periferic apical sting cu distructia arcurilor costale I - IV si a vertebrelor T1-T4
CANCER BRONHO-PULMONARCANCER BRONHO-PULMONAR
Aprecierea extenziei mediastinale prin CTAprecierea extenziei mediastinale prin CT
CANCER BRONHO-PULMONAR DR: CANCER BRONHO-PULMONAR DR: angiocardiografia angiocardiografia demonstreaza extenzia mediastino-pulmonara cu invazie a demonstreaza extenzia mediastino-pulmonara cu invazie a vaselor mari: artera pulmonara (AP) si vena cava vaselor mari: artera pulmonara (AP) si vena cava superioara(VCS)superioara(VCS)
Stenoza/invazie a venei cave superioareStenoza/invazie a venei cave superioare Invazia VCS si arterei pulmonareInvazia VCS si arterei pulmonare
APAPADAD
VDVD
VCSVCS
CAVOGRAFIE SUPERIOARA: CAVOGRAFIE SUPERIOARA: invazie/ tromboza VCSinvazie/ tromboza VCS
CANCER BRONHO-PULMONARCANCER BRONHO-PULMONAR
CANCER PULMONAR CANCER PULMONAR METASTATICMETASTATIC
MODALITATI DE DISEMINARE:MODALITATI DE DISEMINARE: - - HEMATOGENA: HEMATOGENA: noduli opaci gr.II-III, diseminatinoduli opaci gr.II-III, diseminati anarhic, bilateral, inegali; anarhic, bilateral, inegali; nu confluiaza; nu confluiaza; contur net, contur net, forma rotunda forma rotunda (“lansare de baloane”).(“lansare de baloane”). Cauta: Cauta: cancercancerprimitiv teritoriul cav: primitiv teritoriul cav: sin, testicul, rinichi, os, prostata sin, testicul, rinichi, os, prostata
- - LIMFATICALIMFATICA: : limfangiozalimfangioza: diseminare peribonho-: diseminare peribonho-vasculara/ interstitiala parenchimatoasa: vasculara/ interstitiala parenchimatoasa: cordoane,cordoane,micronoduli perihilar/ hiliobazal bilateral; asociere cumicronoduli perihilar/ hiliobazal bilateral; asociere cupleurezie. pleurezie. CautaCauta: : sin, pancreas, stomacsin, pancreas, stomac - - MIXTA: carcinomatoza “miliara”: MIXTA: carcinomatoza “miliara”: diseminare ininterstitiu, limfatic si hematogen: micronoduli diseminati pefond trabecular bilateral; tendinta la conglomerare.Cauta: Cauta: sin, tiroida, digestivsin, tiroida, digestivDg.diferentialDg.diferential:bronhopneumonie, hidatidoza, miliara:bronhopneumonie, hidatidoza, miliara tbc; silicoza, viroze, colagenoze tbc; silicoza, viroze, colagenoze
PNEUMOPATII PNEUMOPATII INFLAMATORIIINFLAMATORII
ACUTEACUTE: : --BACTERIENE:BACTERIENE:
-BACTERIENE SUPURATIVE;-BACTERIENE SUPURATIVE;
-VIRALE (“ATIPICE”);-VIRALE (“ATIPICE”);
CRONICECRONICE: : -TUBERCULOZA;-TUBERCULOZA;
-Alte boli cu componenta -Alte boli cu componenta inflamatorie inflamatorie
PNEUMONII MICROBIENEPNEUMONII MICROBIENE(pneumonia franca lobara)(pneumonia franca lobara)
EtiologieEtiologie: - infectia cu pneumococ, streptococ,etc.: - infectia cu pneumococ, streptococ,etc.
HistopatologieHistopatologie: : -sindrom de umplere alveolara - 4-5 faze:-sindrom de umplere alveolara - 4-5 faze:
Anatomie radiolAnatomie radiologica:ogica: - -congestiecongestie - - VOAL (VOAL (debut)debut)
- - hepatizatiehepatizatie - - BLOC PNEUMONIC BLOC PNEUMONIC
(perioada de stare) - (perioada de stare) - opac, segmente, lobi; opac, segmente, lobi;
- - rezorbtierezorbtie::-- omogena omogena = atenuare sincrona= atenuare sincrona - neomogena - neomogena = “tabla sah”;= “tabla sah”; - de la centru spre- de la centru spre periferie; periferie; -- de la periferie sprede la periferie spre centru centruComplicatiiComplicatii:-:-pleurezii: para/metapneumonicepleurezii: para/metapneumonice -abces secundar-abces secundar
PNEUMONIE BACTERIANA LOB MEDIU: PNEUMONIE BACTERIANA LOB MEDIU:
segment postero - extern segment postero - extern
LATERALLATERAL
1 segment apical
2 segment posterior
3 segment anterior
3x segment axilar
4 segment postero-extern
5 segment antero-intren
6 segment FOWLER
7 segment bazal medial
8 segment bazal anterior
9 segment bazal lateral
10 segment bazal posterior
SEGMENTATIA PULMONARA
Plamin sting: 2b segment apico-dorsal
Lingula: - 4b segment superior
- 5b segment inferior
PNEUMONIE BACTERIANA: PNEUMONIE BACTERIANA: diagnostic diferentialdiagnostic diferential
Pneumonie bacterianaPneumonie bacteriana Atelectazie:cancer endobronsicAtelectazie:cancer endobronsic
PNEUMONIE PNEUMONIE BACTERIANA BACTERIANA REZORBTIEREZORBTIE
AA
B
Tip ITip I
Tip IIITip III
Tip IITip II
BRONHOPNEUMONIABRONHOPNEUMONIA
EtiologieEtiologie: streptococ, pneumococ, Friedlander, E.coli: streptococ, pneumococ, Friedlander, E.coli
Frecventa Frecventa : : nou nascut, batrin, imunodeficienta (SIDA);nou nascut, batrin, imunodeficienta (SIDA);
HistopatologieHistopatologie: : -noduli bronhiolo-alveolar: -noduli bronhiolo-alveolar: - mici (acin);- mici (acin); - mari (lobul);- mari (lobul);
Aspecte radiologiceAspecte radiologice: : - noduli grad I-II; diseminare - noduli grad I-II; diseminare bilateral asimetrica; bilateral asimetrica;
- respecta bazele si apexul;- respecta bazele si apexul; - contur fluu (congestie);- contur fluu (congestie); - centrul opac (bronsiola obstruata);- centrul opac (bronsiola obstruata); - nodulii confluiaza-aspect pseudolobar- nodulii confluiaza-aspect pseudolobar - asincronism evolutiv;- asincronism evolutiv; - asociaza emfizem bulos, travee opace;- asociaza emfizem bulos, travee opace;
Forme specificeForme specifice::-tbc-tbc:evol.subacuta, noduli excavati, caverne:evol.subacuta, noduli excavati, caverne --stafilococicastafilococica: pneumatocele, complicatii: pneumatocele, complicatiisupurative (piotorax,abcese multiple); supurative (piotorax,abcese multiple); gravitate majora.gravitate majora.
Pneumopatii acute supuratePneumopatii acute supurateABCESUL ABCESUL PULMONARPULMONAR
PatogeniePatogenie: - bronhogen (aerogen, abcedarea pneumoniei);: - bronhogen (aerogen, abcedarea pneumoniei); - hematogen (septicopioemie);- hematogen (septicopioemie); - contiguitate (plagi, fracturi, post-operator);- contiguitate (plagi, fracturi, post-operator);
Etiologie: stafilococ, streptococ, Friedlander, amoebian etc.
Anatomie radiologicaAnatomie radiologica: :
- stadiu pre-supurativ - stadiu pre-supurativ (pre-vomica): bloc pneumonic atipic, (pre-vomica): bloc pneumonic atipic, ”amputat”; opacitate centrala intensa, ”amputat”; opacitate centrala intensa,
nodulara;nodulara;- stadiu supurativ - stadiu supurativ ((post-vomica): post-vomica): -recent:”gura de cuptor”- imagine -recent:”gura de cuptor”- imagine
hidro-aerica cu nivel inalt, liniar, neted si congestie in hidro-aerica cu nivel inalt, liniar, neted si congestie in jur;jur; -vechi: cronicizare (sapt.) - nivelul lichidian si congestia scad, inel -vechi: cronicizare (sapt.) - nivelul lichidian si congestia scad, inel
opac periferic, gros (membrana piogena), cavitate cu perete opac periferic, gros (membrana piogena), cavitate cu perete rigid.rigid.- complicatii: - complicatii: piotorax; pio-pneumotorax.piotorax; pio-pneumotorax.
EvolutieEvolutie: - vindecare; sechele fibroase;: - vindecare; sechele fibroase; - cronicizare impune tratament chirurgical- cronicizare impune tratament chirurgical
ABCES PULMONAR: faza pre-vomicaABCES PULMONAR: faza pre-vomicaABCES PULMONAR: faza pre-vomicaABCES PULMONAR: faza pre-vomica
ABCES PULMONAR SECUNDARABCES PULMONAR SECUNDARABCES PULMONAR SECUNDARABCES PULMONAR SECUNDAR
Nivel Nivel hidroaerichidroaeric
pneumonie
pleureziepleurezie
ABCES ABCES PULMONARPULMONAR
IN FAZA CRONICAIN FAZA CRONICA
““CHIRURGICAL”CHIRURGICAL”
ABCES ABCES PULMONARPULMONAR
IN FAZA CRONICAIN FAZA CRONICA
““CHIRURGICAL”CHIRURGICAL”
Pneumopatii acute supuratePneumopatii acute supurate
STAFILOCOCIA PLEURO-PULMONARASTAFILOCOCIA PLEURO-PULMONARA
Copil 0-1 an; SIDA; alte imunodeficienteCopil 0-1 an; SIDA; alte imunodeficiente
Anatomie radiologica:Anatomie radiologica: - noduli bronhopneumonici; - noduli bronhopneumonici; - pneumonie extensiv/ - pneumonie extensiv/ agresiva;agresiva; - abcedare- abcedare - pneumatocele gigante;- pneumatocele gigante; - pleurezii purulente- pleurezii purulente
- piopneumotorax- piopneumotorax
Evolutie:Evolutie: grava, rapida (ore). grava, rapida (ore).
GANGRENA GANGRENA PULMONARAPULMONARA Supuratie grava cu germeni anaerobi; asociata cu imunodeficienta;Supuratie grava cu germeni anaerobi; asociata cu imunodeficienta;
Anatomie radiologicaAnatomie radiologica: focare pneumonice, necroze masive si abcese;: focare pneumonice, necroze masive si abcese;
Imagini complexe: opacitati extinse, imagine hidro-aericeImagini complexe: opacitati extinse, imagine hidro-aerice
multiplemultiple
SUPURATIE PULMONARA STAFILOCOCICASUPURATIE PULMONARA STAFILOCOCICA
11 2 a2 a 2 b2 b
Dupa 24 hDupa 24 h
PNEUMOPATII ACUTE PNEUMOPATII ACUTE NEBACTERIENENEBACTERIENE
PNEUMONII INTERSTITIALE, ATIPICEPNEUMONII INTERSTITIALE, ATIPICEEtiologieEtiologie: virusuri:: virusuri: influenzae, paragripale, adenovirus, respirator influenzae, paragripale, adenovirus, respirator
sincitial, myxovirus, mycoplasma pneumoniae, rujeolic,bacil sincitial, myxovirus, mycoplasma pneumoniae, rujeolic,bacil pertusis, pertusis,
Ricketsia Burnetti, ornitoza, psitacoza Ricketsia Burnetti, ornitoza, psitacoza
PatogeniePatogenie: : infectie aerogena (picaturi Pflüge) - bronsiolita;infectie aerogena (picaturi Pflüge) - bronsiolita; infiltratie parietala bronsica, peribronhovasculara, limfangita;infiltratie parietala bronsica, peribronhovasculara, limfangita; edem bronsiolar,obstructie bronsica, mecanism de supapa; edem bronsiolar,obstructie bronsica, mecanism de supapa; atelectazii acinare, bule de emfizematelectazii acinare, bule de emfizem..Aspecte RxAspecte Rx:-:-infiltrat hiliobazal: infiltrat hiliobazal: gripal Dittmar gripal Dittmar RupertRupert
-”aripi fluture”perihilar, reticulogranitat, noduli miliari -”aripi fluture”perihilar, reticulogranitat, noduli miliari
acinari (atelectazii acinare), bule de emfizemacinari (atelectazii acinare), bule de emfizem ..ComplicatiiComplicatii: : bronhopneumonie, pneumonie, bronhopneumonie, pneumonie, pleurezii pleurezii
PNEUMONIE INTERSTITIALA: GRIPAPNEUMONIE INTERSTITIALA: GRIPAPNEUMONIE INTERSTITIALA: GRIPAPNEUMONIE INTERSTITIALA: GRIPA
TRIUNGHIULTRIUNGHIUL DITTMAR RUPERT DITTMAR RUPERT
PNEUMOPATII ACUTEPNEUMOPATII ACUTE
INTERSTITIALEINTERSTITIALE
RUJEOLARUJEOLA
TUSE CONVULSIVATUSE CONVULSIVA
PNEUMOPATII PNEUMOPATII ACUTEACUTE
INTERSTITIALE:INTERSTITIALE:
COMPLICATIICOMPLICATII
PNEUMOPATII PNEUMOPATII ACUTEACUTE
INTERSTITIALE:INTERSTITIALE:
COMPLICATIICOMPLICATII
BRONHOPNEUMONIE
PNEUMONIE PNEUMONIE SEGMENTARASEGMENTARA
TUBERCULOZA PULMONARATUBERCULOZA PULMONARA
EtiologieEtiologie::
Bacil Koch (BK); cale contaminare: aeriana(Pflüge)Bacil Koch (BK); cale contaminare: aeriana(Pflüge)
CLASIFICARE:CLASIFICARE:
Tuberculoza primaraTuberculoza primara(primoinfectia);(primoinfectia);
Tuberculoza secundara Tuberculoza secundara (ftizia)(ftizia)
Tuberculoza pulmonara primaraTuberculoza pulmonara primara
Copil: 2-7 ani, rar adolescent.Copil: 2-7 ani, rar adolescent.
Anatomie radiologicaAnatomie radiologica: : COMPLEX PRIMAR COMPLEX PRIMAR RANCKE:RANCKE:
afect primar afect primar => => limfangitalimfangita=> => adenitaadenita
(sancru inoculare=alveolita acinara)(sancru inoculare=alveolita acinara)
Complex integral = “in haltera”Complex integral = “in haltera” Obisnuit este vizibila doar adenopatia satelita, paratrahealaObisnuit este vizibila doar adenopatia satelita, paratraheala
EVOLUTIE:EVOLUTIE: - 90% - 90% vindecare spontanavindecare spontana, ad integrum, ad integrum
sechele cicatrici fibro-calcare; viraj tuberculinic - imunitate;sechele cicatrici fibro-calcare; viraj tuberculinic - imunitate;
- 10% - 10% complicatiicomplicatii:: miliara; bronhopneumonie; miliara; bronhopneumonie; pneumonie cazeoasa cavitara;pneumonie cazeoasa cavitara;
caverna primara (asociat adenopatie)caverna primara (asociat adenopatie)
COMPLEX PRIMAR TUBERCULOSCOMPLEX PRIMAR TUBERCULOS
AFECTAFECT
LIMFANGITALIMFANGITA
ADENITAADENITA
RANCKERANCKE
COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: congestie perifocalacongestie perifocala
COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: congestie perifocalacongestie perifocala
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= diseminarea hematogena= miliara tbcmiliara tbc
COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: diseminarea hematogena= diseminarea hematogena= miliara tbcmiliara tbc
ADENITAADENITA
ADENITAADENITA
COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: pneumonia cazeoasapneumonia cazeoasa
COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: pneumonia cazeoasapneumonia cazeoasa
SECHELE DUPA TBC PRIMARA:SECHELE DUPA TBC PRIMARA:
NODULI FIBROSINODULI FIBROSI APICALI SI APICALI SI
SUBCLAVICULARI;SUBCLAVICULARI;
CALCIFICARICALCIFICARI IN PARENCHIM IN PARENCHIM
SI GANGLIONII REGIONALISI GANGLIONII REGIONALI
TUBERCULOZA SECUNDARATUBERCULOZA SECUNDARA
1 1 Noduli fibrosi apico-subclaviculari: Noduli fibrosi apico-subclaviculari: potential ftizio-
geni(BK “dormant”=>reactivare); Rx=micronoduli tip
Simon, Aschoff-Puhl,Hedwall;reactivare - leziune
activa subclaviculara.2 2 Infiltratul precoce subclavicular: Infiltratul precoce subclavicular: alveolita exsudativaalveolita exsudativa
nevindecabila spontan;nevindecabila spontan;Rx=Rx=nodul palid gr.II tip Assman(ro-nodul palid gr.II tip Assman(ro-
tund),Fleischner(oval),Redecker(patrulater),Dufour(nebulostund),Fleischner(oval),Redecker(patrulater),Dufour(nebulos))
Evolutie:necroza - cazeificare - excavare - CAVERNACAVERNA
Caverna recenta:Caverna recenta:”racheta de tenis”:infiltrat partial excavat cu”racheta de tenis”:infiltrat partial excavat cubronsie de drenaj inflamata;bronsie de drenaj inflamata;Caverna elasticaCaverna elastica: : hipertransparentahipertransparentacircumscrisa,ax mare orizontal,pereti supli;circumscrisa,ax mare orizontal,pereti supli;Caverna scleroasaCaverna scleroasa::pereti grosi,rigizi,contur neregulat,fibroza si lez combinate in pereti grosi,rigizi,contur neregulat,fibroza si lez combinate in jurjur
NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI
Infiltrat Infiltrat precoceprecoce
gglggl
FTIZIOGENEZA APICALAFTIZIOGENEZA APICALA
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=CAVERNADEBUT AL FTIZIEI ADULTULUI=CAVERNADEBUT AL FTIZIEI ADULTULUI=CAVERNADEBUT AL FTIZIEI ADULTULUI=CAVERNA
TUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATomografie planaTomografie plana
TBC SECUNDARA=FTIZIATBC CAZEOASA -CAVITARA: TBC CAZEOASA -CAVITARA: caverna solitara; sistemecaverna solitara; sisteme
de caverne (“miez de pîine”); pneumonie cazeoasa; de caverne (“miez de pîine”); pneumonie cazeoasa;
bronhopneumonie.bronhopneumonie.
TUBERCULOMUL: TUBERCULOMUL: nodul gr.II, intens, fibrocalcar = nodul gr.II, intens, fibrocalcar =
infiltrat blocat cu potential de reactivare.infiltrat blocat cu potential de reactivare.
TBC FIBROASA: TBC FIBROASA: forme minore/ majore - FIBROTORAXforme minore/ majore - FIBROTORAX
TBC HIPERCRONICA: TBC HIPERCRONICA: caverne scleroase, fibroza exten-caverne scleroase, fibroza exten-
siva, pahipleurite,bronsiectazii, emfizem.siva, pahipleurite,bronsiectazii, emfizem.
Forme particulare: Forme particulare: MILIARA adultului; PLEUREZIA.MILIARA adultului; PLEUREZIA.
COMPLICATII/SECHELE: COMPLICATII/SECHELE: HEMOPTIZIA; FIBRO-HEMOPTIZIA; FIBRO-
TORAX; CORD PULMONAR CRONIC; AMILOIDOZA TORAX; CORD PULMONAR CRONIC; AMILOIDOZA
FTIZIE: CAVERNA GIGANTAFTIZIE: CAVERNA GIGANTAFTIZIE: CAVERNA GIGANTAFTIZIE: CAVERNA GIGANTA
Diseminare controlaterala
TUBERCULOZA EXTENSIVA CAZEOASA TUBERCULOZA EXTENSIVA CAZEOASA
-Sisteme de -Sisteme de cavernecaverne
-pneumonie -pneumonie cazeoasa cazeoasa lob inferior lob inferior stingsting
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
FTIZIEFTIZIE:DISEMINARE MILIARA IN:DISEMINARE MILIARA IN
TUBERCULOZA SECUNDARA TUBERCULOZA SECUNDARA
FTIZIEFTIZIE:DISEMINARE MILIARA IN:DISEMINARE MILIARA IN
TUBERCULOZA SECUNDARA TUBERCULOZA SECUNDARA
FTIZIE HIPERCRONICA & SECHELARAFTIZIE HIPERCRONICA & SECHELARAFTIZIE HIPERCRONICA & SECHELARAFTIZIE HIPERCRONICA & SECHELARA
FIBROTORAX TUBERCULOSFIBROTORAX TUBERCULOSFIBROTORAX TUBERCULOSFIBROTORAX TUBERCULOS