Pulmonar 2
Pulmonar 2
Pulmonar 2
PULMONARA
DIAGNOSTIC
RADIOLOGIC /
IMAGISTIC
Patologie bronsica
I.DISPLAZII CHISTICE
II.B.P.O.C.
III.BRONSIECTAZII
IV.BRONHOCEL
V.MUCOVISCIDOZA
VI.CORPI STRAINI TRAHEO-BRONSICI
VII.CANCER BRONHO-PULMONAR
I.Displazii
chistice
Definitie: malformatii congenitale ale mugurelui bronsic
terminal (bronsiolar).
CHISTUL SOLITAR
POLICHISTOZA: segmentara, lobara, pulmonara
Descriere radiologica:
- hipertransparenta rotund-ovalara;
- perete fin;
-
Patologie bronsica
Tomografii plane
Boala segmentara
CHISTURI AERIENE
MULTIPLE
CHISTURI
AERIENE:
MULTIPLE,
ABCEDATE
II.B.P.O.C. =>Afectarea bronsiilor mici
1.BRONSITA CRONICA:
Rx.standard: -desen pulm.hilio-bazal intarit;
Bronhografie:-arbore mort;dilatatii cilindrice;
-decalibrari bronsice;
-ulceratii ale gl.bronsice=>nise,spiculi
2.EMFIZEM PULMONAR:
Distensie;-hipertransparenta(ruptura pereti alveolari si
distrugerea patului capilar).
BRONSITA DEFORMANTA
III.BRONSIECTAZI=dilatari bronsice
I
A).CONGENITALE:-sd.malformative complexe:
Sd.KARTAGENER: - situs inversus, etmoido-antrita(surditate)
bronsiectazii chistice
Sd.MEUNIER-KHN: - idem, fara situs inversus.
B).DOBINDITE:=>dupa BPOC;sec.altor
afectiuni
(tractiuni
Rx.standard: imagini chistice parietale
n captul unor liniiexterne)
clare - rozeta
Ameuille,fagure,lemn mncat de carii(cnd
carii bronhia este goal) i de opaciti
liniare terminate n deget de mnu (cnd bronhia este plin)
-ciorchine,cordoane etc;
- bronsiectatic hilio-bazal
Bronhografia:-cilindrice;moniliforme;
ampulare;sacciforme;chistice.
Triunghiul bronsiectatic
BRONHOGRAFIA
IN
BRONSIECTAZII
VII.CANCER BRONO-
PULMONAR
Cea mai frecventa localizare;locul 1 mortalitate..!! FUMATUL!!
Histopatologie:-epitelial epidermoid(squamos);
adenocarcinom;celula mica (oat cells);sarcom.
BRONHOGRAFIE(A)+TOMOGRAFIE(B)
CANCER ENDOBRONSIC
CANCER EXOBRONSIC-
MASIV AL HILULUI
Krebs fsse
CANCER NODULAR PERIFERIC
CANCER
NODULAR
PERIFERIC
A
Computer tomografie:
A).fereastra pulmon;
B).fereastra mediastin
B
ROLUL
EX.IMAGISTICE
1)EVIDENTIAZA TUMORA:-Rx.standard,bronhografia,CT.
Aspecte:-cancer
hilar(central)endobronsic=>atelectazie
(segment,lob,pulmon);emfizem sist.
(rar);bronhografie:sten.
amputatii (STOP);dg.dif.:pneumonie;
-cancer hilar (central)exobronsic=>nodul
opac
hilar + prelungiri radiare=krebs fsse(picioare
crab) -cancer periferic,nodular=>nodul opac
gr.II-
dg.dif.:adenopatie,anevrism a.pulm.;
III,contur neregulat (prelungiri..),intensitate
mare;
dg.dif.:chist hidatic,tuberculom,hamartom.
ROLUL
EX.IMAGISTICE
2)APRECIAZA EXTENZIA LOCO-REGIONALA
Metode:-tomogr.US ,CT,cavografia,art.pulmonara,IRMN.
Aspecte:-extenzia mediastinala=>adenopatie,sten/tromb VCS;
-extenzia parietala=>apex=>Sd.Pancoast-Tobias;
-extenzia lobara=>cancer lobar (lobita carcinomat)
-invazie pericard=>pericardita=>eco-cardiografia !
3)EVIDENTIAZA COMPLICATIILE
-necroza=>excavare=>suprainfectia;
-invazia costala,pleurala
4)DECELEAZA METASTAZELE
-OS=>scintigr.Tc99;CREER=>IRMN,CT;FICAT,SR=>US
CANCER EXTINS LOBAR
Sd.PANCOAST-TOBIAS
Aprecierea
extenziei
mediastinale
prin CT
Stenoza/invazie a venei cave sup. InvaziaVCS si arterei pulmonare
VCS
AP
AD
VD
II.CRONICE:-TUBERCULOZA;
-Alte boli cu componenta
inflamat.
I.PNEUMONII MICROBIENE
(..franca lobara).
Etiologie:-infectia cu pneumococ,streptococ,etc.
Histoppatologie:-sd.de umplere alveolara=>4-5 faze:
Anatomie radiol.:=> -congestie=VOAL;(debut)
- tes.fibrino-hem<=>-hepatizatie=>BLOC PNEUMONIC
(stare) => opac,segmente,lobi;
-retur anat.patol. =>-rezorbtie:-omogena=atenuare sincrona
-neomogena=tabla sah;
-centru=>periferie;
-periferie=>centru
Complicatii:-pleurezii-para/meta-pneumonice
-abces secundar.
LATERAL
PNEUMONIE BACTERIANA LOB MEDIU
PNEUMONIE BACTERIANA LOB MEDIU
Segment axilar
LINGULA
FOCARE PNEUMONICE
MULTIPLE
Pneumonie bacteriana Atelectazie:cancer endobronsic
REZORBTIA
PNEUMONIEI
Tip III B
II.BRONHOPNEUMONI
A
Etiologie:streptococ,pneumococ,Friedlander,..colibacil etc.
Etiologie:streptococ,pneumococ,Friedlander,..colibacil etc.
Frecventa max:-nou nascut,batrin,imunodeficienta (SIDA);
Histopatologie: -nodulul bronhiolo-alveolar:-mici (acin);
-mari (lobul);
Aspecte radiologice:-grad I-II;diseminare bilat.asimetrica;
-respecta bazele si apexul;
-contur fluu (congestie);
-centru opac (bronsiola obstruata);
-confluiaza=>pseudolobar;
-asincronism evolutiv;
-asociaza emfizem bulos,travee opace;
Forme specifice:-tbc:evol.subacuta,noduli excavati=caverne
-stafilococica:-pneumatocele,complicatii
supurative (piotorax,abcese multiple);gravitate majora !
BRONHOPNEUMONIE
BRONHOPNEUMONIE
BRONHOPNEUMONIE
FORMA PSEUDOLOBARA
Pneumopatii acute supurate
ABCESUL
PULMONAR
Etiologie:-amoebian,stafilo,strepto,Friedlander,etc.
Mec.patogenic:-bronhogen(aerogen..abcedarea pneumoniei);
-hematogen(septico-pioemie);
-contiguitate(plagi,fracturi,post-operator);
Anat-radiol.:-a)stadiu pre-supurativ(pre-
vomica):bloc
pneumonic atipic,amputat;opacit. centrala
intensa,nodulara;
b)stadiu supurativ(post-vomica)-recent:gura de
cuptor:
imagine hidro-aerica,nivel inalt,liniar,neted;congestie in jur;
-vechi=>cronicizare (sapt):nivel lichid.& congestia inel opac
periferic,gros(membrana piogena),cavitate ne-elastica.
C)stadiul complicatiilor:-piotorax;pio-pneumotorax.
Evolutie:-vindecare;sechele fibroase;
Nivel hidroaeric
pneumonie
pleurezie
ABCES
ABCESPULMONAR:faza
PULMONAR:faza ABCES
ABCESPULMONAR
PULMONAR
pre-vomica
pre-vomica SECUNDAR
SECUNDAR
ABCES PULMONAR SECUNDAR PNEUMONIEI
ABCES
PULMONAR
IN FAZA
CRONICA
CHIRURGICAL
PNEUMOPATII ACUTE
NEBACTERIENE
PNEUMONII INTERSTITIALE,ATIPICE
Etiologie:-virusuri:-influenzae(gripa!),paragripale,adenovirus,respirat.
sincitial,,myxovirus,mycoplasma pneumoniae (ag.EATON),v.rujeolic,
bacil pertusis (tuse convulsiva),Ricketsia Burnetti,ornitoza,psittacoza
Mec.patogenic:-inf.aerogena (pic.Flge)=>bronsiolita;
infiltr.parietala br.,peribronhovascular;limfangita;
edem bronsiolar,obstructie br.;mec.supapa;atelectazii
acinare;bule de emfizem.
Aspecte Rx:-infiltrat hiliobazal: gripal Dittmar/Rupert
-aripi flutureperihilar;-reticulogranitat,noduli miliari
acinari(ateleczii acinare);bule emfizem.
Complicatii:-bronhopneumonie,pneumonie,pleurezii
mici.
TRIUNGHIUL DITTMAR & RUPPERT
PNEUMONIE
PNEUMONIEINTERSTITIALA:GRIPA
INTERSTITIALA:GRIPA
PNEUMOPATII ACUTE
INTERSTITIALE
RUJEOLA
TUSE CONVULSIVA
PNEUMOPATII
PNEUMOPATII
ACUTE
ACUTE
INTERSTITIALE:
INTERSTITIALE:
COMPLICATII
COMPLICATII
BRONHOPNEUMONIE
PNEUMONIE
SEGMENTARA
TUBERCULOZA PULMONARA
Etiologie:
Bacil Koch (BK);cale contaminare:aeriana(Flge)
CLASIFICARE:
ADENITA
LIMFANGITA
RANCKE
COMPLEX PRIMAR TUBERCULOS
COMPLEX
COMPLEXPRIMAR
PRIMARTBC TBCCOMPLICAT:
COMPLICAT:
congestie perifocala
COMPLEX
COMPLEXPRIMAR
PRIMARTBCTBCCOMPLICAT:
COMPLICAT:
periadenita
periadenita
ADENITA
COMPLEX
COMPLEXPRIMAR
PRIMARTBC
TBCCOMPLICAT:
COMPLICAT:
diseminarea
diseminareahematogena=
hematogena=miliara
miliaratbc
tbc
ADENITA
COMPLEX
COMPLEXPRIMAR
PRIMARTBC
TBCCOMPLICAT:
COMPLICAT:
pneumonia cazeoasa
pneumonia cazeoasa
SECHELE DUPA TBC PRIMARA:
-NODULI FIBROSI APICALI SI
SUBCLAVICULARI;
-CALCIFICARI IN PARENCHIM
SI GANGLIONII REGIONALI
TUBERCULOZA SECUNDARA
1).Noduli fibrosi apico-subclaviculari:potential
apico-subclaviculari: ftizio-
geni(BK dormant=>reactivare);Rx=micronoduli tip
Simon,Aschoff-Puhl,Hedwall;reactiv=>migrare s.clav.
2).Infiltratul precoce subclavicular:=alveolita exsudativa
nevindecabila spontan;Rx=nodul palid gr.II tip Assman(ro-
tund),Fleischner(oval),Redecker(patrulater),Dufour(nebulos
)
Evolutie:necroza=>cazeificare=>excavare=>CAVERNA
Caverna recenta:racheta de tenis:infiltrat partial excavat+
bronsie drenaj inflamata;Caverna elastica: hipertransparenta
circumscrisa,ax mare orizontal,pereti supli;Caverna scleroasa:
pereti grosi,rigizi,contur neregulat,fibroza+lez combinate in jur.
FTIZIOGENEZA APICALA.
Infiltrat
precoce
ggl
NODULI
NODULIFIBROSI
FIBROSIAPICALI
APICALI=>POTENTIAL
=>POTENTIALFTIZIOGENI
FTIZIOGENI !!!!
Infiltrat in curs de
excavare
Zile..saptamini
paleta
coada
INFILTRAT
INFILTRAT PRECOCE
PRECOCE TBC==>
TBC==>
==>
==> DEBUTUL
DEBUTUL FTIZIEI..
FTIZIEI.. racheta de tenis
Tomografie
Tomografieplana
plana
TUBERCULOM
TUBERCULOMAPICAL
APICAL
DEBUT
DEBUTAL
ALFTIZIEI
FTIZIEIADULTULUI=CAVERNA..
ADULTULUI=CAVERNA..
Tomografie plana
TUBERCULOZA
TUBERCULOZACAZEOASA
CAZEOASACAVITARA
CAVITARA
forme TBC SECUNDARA=FTIZIA
TBC CAZEOASA -CAVITARA:caverna solitara;-sisteme
de caverne (miez de pine);pneumonie cazeoasa;bronho-
pneumonie.
TUBERCULOMUL:-nodul gr.II,intens,fibro/calcar=infiltr
blocat=>potential reactivare.
TBC FIBROASA:-forme minore/maJORE.
TBC HIPERCRONICA:-caverne scleroase+fibroza exten-
siva+pahipleurite+bronsiectazii+emfizem.
COMPLICATII/SECHELE:-HEMOPTIZIA;FIBRO-
TORAX;CORD PULMONAR CR.;AMILOIDOZA etc.
Diseminare
controlaterala
FTIZIE:
FTIZIE:CAVERNA
CAVERNAGIGANTA
GIGANTA
-Sisteme de caverne
-pneumonie cazeoasa lob inf.
Caverne+infiltrate+fibroza
Caverne+infiltrate+fibroza
TUBERCULOZA
TUBERCULOZACAZEOASA
CAZEOASACAVITARA
CAVITARA
FTIZIE;
FTIZIE;PNEUMONIE
PNEUMONIECAZEOASA
CAZEOASACAVITARA
CAVITARA
FTIZIE:DISEMINARE BRONHOPNEUMONICA
FTIZIE
FTIZIE:DISEMINARE
:DISEMINAREMILIARA
MILIARAIN
IN
TUBERCULOZA
TUBERCULOZASECUNDARA
SECUNDARA