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    Dr. Alexandru Andritoiu Ecografia Pulmonara in Covid 19

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    Cristi Zamfir

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    Dr. Alexandru Andritoiu Ecografia Pulmonara in Covid 19

    Uploaded by

    Cristi Zamfir
    8 views36 pages

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    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    8 views36 pages

    Dr. Alexandru Andritoiu Ecografia Pulmonara in Covid 19

    Uploaded by

    Cristi Zamfir

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 36

    Ecografia pulmonara

    in Covid-19

    Alexandru Andritoiu
    Sp. Militar Craiova
    Diagnosticul Covid-19
    • Simptomatologie diversa-multidisciplinara
    • Teste controversate
    • Imagistica inselatoare

    • Afectarea pulmonara: cea mai frecventa


    • Pneumonia bilaterala
    • Diverse stadii de evolutie

    • Protocoalele se modifica periodic!


    Pneumonia Covid-19
    Evolutie stadiala-progresiva

    1) interstitiala
    2) alveolo-interstitiala
    3) condensari subpleurale
    4) condensari segmentare/lobare
    5) fibrioza
    6) f. rar pleurezie (minima)

    10% dintre pacientii cu Covid-19 nu dezvolta afectare pulmonara !


    Caracteristici

    • Postero-bazal
    • Bilaterala
    • Periferica
    • Progresiva
    • F rar: -unilaterala
    Pneumonia Covid-19

    Bilaterala
    LSD
    Imagistica

    Indicatii controversate:

    • Rx-CP
    • CT toracic (nativ)
    • US pulmonara
    Rx-CP

    Forma moderata Forma severa

    CxR is used more frequently than CT in USA


    Multifocal bilateral pulmonary opacities are nonspecific
    but most characteristic of COVID-19 PNM
    CT toracic (nativ)

    High Sb. (88-97%


    Low Sp. (<25%)

    Groud-Glass Opacities (patchy)


    Crazy paving
    Reverse Halo Sign (organized PNM)
    DAD-Diffuse Alveolar Damage (ARDS)
    Consolidations
    Pleural effusion (3-5%) Chest CT Severity score
    Bilateral>Unilateral (low/mild/high)
    CT normal la debut

    V. Lucia, 51 ani
    Febra 38C, frisoane - 2 zile
    SpO2 98%-Ag rapid SARS-Cov 2= POZITIV
    ARDS-ATI

    F. Maria, 72 ani
    CT: condesari pneumonice bilaterale cu bronhograma aerica
    prezenta dupa tentativa de IOT
    Traumatism toracic
    Contuzie pulmonara vs Covid-19
    US pulmonara
    Indicatii consacrate:

    • pleurezie
    • toracenteza
    • abces pulmonar
    • PNTx
    • tumori periferice
    • PNM segmentara
    • atelectazie
    • TEP
    Neo br-pulm
    Abces pulmonar
    Meta-pleurezie neo
    Drenaj percutan
    US pulmonara in Covid-19
    • Nu necesita aparatura de ultima
    generatie
    • Transductorul liner, convex, sectorial
    • Cateva setari (gain, depth, zoom)
    • Programul: Abdomen
    B-Mode US
    B-mode M-mode

    Pleural line
    Lung sliding
    A-lines vs B-lines

    Bazata pe ARTERFACTE DE REVERBERATIE


    Semnul farului

    Se deplaseaza cu respiratia
    Consolidari subpleurale
    Scor de severitate
    (0p-3p)
    • Util in evaluarea prognostica
    • Monitorizarea terapeutica
    We suggest clinicians facing the nCoV-19 outbreak to use and evaluate
    the role of lung ultrasound in patients with nCoV-19.
    Caz clinic
    V. Florin, 50 ani
    febra 38C,
    cefalee intensa,
    transpiratii nocturne
    tuse rara-seaca,
    toleranta redusa la efort
    TGO 67 UI/L, TGP 61UI/L
    CRP: 13 mg/dL
    Diagnostic diferential

    • Alte viroze respiratorii


    • Alte af. interstitiale
    • Staza pulmonara
    • Fibrozele pulmonare
    F, 79 ani, dispnee

    US
    • Protezare Mi-Ao
    • Fi.A cronica
    • ICC
    Radiology

    Rx CP CT
    Staza vs Covid-19?

    IgM si IgG Ab-neg, rt-PCR-neg


    NT-proBNP 2052 ng/mL
    Dupa 5 zile…

    • Furosemid
    • Nitrat
    • Digoxin
    • …etc.

    A profile
    Edem pulmonar
    Fibroza pulmonara

    T Maria, 66 ani
    Tuse, dispnee, fatigabilitate
    Ag Covid-19: NEGATIV
    Concluzii

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