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Curs Pulmon+Cord BFT Modif

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Page 1: Curs Pulmon+Cord BFT Modif
Page 2: Curs Pulmon+Cord BFT Modif

I.I.ACUTEACUTE: -: -BACTERIENE:BACTERIENE:

-BACTERIENE SUPURATIVE;-BACTERIENE SUPURATIVE;

-VIRALE (“ATIPICE”);-VIRALE (“ATIPICE”);

IIII.CRONICE.CRONICE::--TUBERCULOZA;TUBERCULOZA;

-Alte boli cu componenta -Alte boli cu componenta inflamat.inflamat.

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EtiologieEtiologie:-infectia cu pneumococ,streptococ,etc.:-infectia cu pneumococ,streptococ,etc.

Aspect radiologic: - opacitate sistematizata (segmentara sau lobara) Aspect radiologic: - opacitate sistematizata (segmentara sau lobara)

- intensitate medie- intensitate medie

- omogena - omogena

- bronhograma aerica prezenta- bronhograma aerica prezenta

- imprecis conturata - imprecis conturata

- forma aproximativ triunghiulara cu varful catre hil- forma aproximativ triunghiulara cu varful catre hil

- delimitarea data de o scizura determina netitatea - delimitarea data de o scizura determina netitatea conturului.conturului.

Evolutie – extensie homo sau contralateralaEvolutie – extensie homo sau contralaterala

- resorbtie completa - resorbtie completa centripeta sau centrifuga centripeta sau centrifuga

ComplicatiiComplicatii:-pleurezii-para/meta-pneumonice:-pleurezii-para/meta-pneumonice -abces secundar.-abces secundar.

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PNEUMONIE BACTERIANA LOB MEDIUPNEUMONIE BACTERIANA LOB MEDIU

LATERALLATERAL

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PNEUMONIE BACTERIANA LOB MEDIUPNEUMONIE BACTERIANA LOB MEDIU

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PNEUMONIE BACTERIANA LOB SUPERIORPNEUMONIE BACTERIANA LOB SUPERIOR

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PNEUMONIE BACTERIANA PLURISEGMENTARAPNEUMONIE BACTERIANA PLURISEGMENTARA

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FOCARE PNEUMONICEFOCARE PNEUMONICE

MULTIPLEMULTIPLE

FOWLERFOWLER

LINGULALINGULA

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PNEUMONIE BACTERIANA:diagnostic diferentialPNEUMONIE BACTERIANA:diagnostic diferential

Pneumonie bacterianaPneumonie bacteriana Atelectazie:cancer endobronsicAtelectazie:cancer endobronsic

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PNEUMONIE BACTERIANA ACUTAPNEUMONIE BACTERIANA ACUTA

BRONHOGRAMA AERICABRONHOGRAMA AERICA

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EtiologieEtiologie:streptococ,pneumococ,Friedlander,..colibacil etc.:streptococ,pneumococ,Friedlander,..colibacil etc.

Frecventa maxFrecventa max:-nou nascut,batrin,imunodeficienta (SIDA);:-nou nascut,batrin,imunodeficienta (SIDA);

HistopatologieHistopatologie: -nodulul bronhiolo-alveolar:-mici (acin);: -nodulul bronhiolo-alveolar:-mici (acin); -mari (lobul);-mari (lobul);

Aspecte radiologiceAspecte radiologice::-grad I-II;diseminare bilat.asimetrica;-grad I-II;diseminare bilat.asimetrica; -respecta bazele si apexul;-respecta bazele si apexul; -contur fluu (congestie);-contur fluu (congestie); -centru opac (bronsiola obstruata);-centru opac (bronsiola obstruata); -confluiaza=>pseudolobar;-confluiaza=>pseudolobar; -asincronism evolutiv;-asincronism evolutiv; -asociaza emfizem bulos,travee opace;-asociaza emfizem bulos,travee opace;

Forme specifice:Forme specifice:-tbc:evol.subacuta,noduli excavati=caverne-tbc:evol.subacuta,noduli excavati=caverne -stafilococica:-pneumatocele,complicatii-stafilococica:-pneumatocele,complicatiisupurative (piotorax,abcese multiple);gravitate majora !supurative (piotorax,abcese multiple);gravitate majora !

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BRONHOPNEUMONIEBRONHOPNEUMONIE

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BRONHOPNEUMONIEBRONHOPNEUMONIE

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BRONHOPNEUMONIEBRONHOPNEUMONIE

FORMA PSEUDOLOBARAFORMA PSEUDOLOBARA

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ABCESUL ABCESUL PULMONARPULMONAR

Mec.patogenic:Mec.patogenic:-bronhogen(aerogen..abcedarea pneumoniei);-bronhogen(aerogen..abcedarea pneumoniei); -hematogen(septico-pioemie);-hematogen(septico-pioemie); -contiguitate(plagi,fracturi,post-operator);-contiguitate(plagi,fracturi,post-operator);

Etiologie:-amoebian,stafilo,strepto,Friedlander,etc.

Aspect radiologicAspect radiologic

a)a)Constituire – opacitate rotunjita, contur imprecis, omogena, Constituire – opacitate rotunjita, contur imprecis, omogena, noduli perilezionalinoduli perilezionali

b)b)Supuratie colectata – imagine hidroaerica cu nivel orizontal, Supuratie colectata – imagine hidroaerica cu nivel orizontal, imobila cu miscarile pacientului, contur interior initial imobila cu miscarile pacientului, contur interior initial anfractuosanfractuos

• Infiltrat pneumonic perilezionalInfiltrat pneumonic perilezionalEvolutieEvolutie:-vindecare;sechele fibroase;:-vindecare;sechele fibroase; -cronicizare…=>trat.chirurgical-cronicizare…=>trat.chirurgical

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ABCES PULMONAR:faza ABCES PULMONAR:faza pre-vomicapre-vomica

ABCES PULMONAR:faza ABCES PULMONAR:faza pre-vomicapre-vomica

ABCES PULMONAR ABCES PULMONAR SECUNDARSECUNDAR

ABCES PULMONAR ABCES PULMONAR SECUNDARSECUNDAR

Nivel hidroaericNivel hidroaeric

pneumonie

pleureziepleurezie

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ABCES PULMONAR SECUNDAR PNEUMONIEIABCES PULMONAR SECUNDAR PNEUMONIEI

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ABCES ABCES PULMONARPULMONAR

IN FAZA IN FAZA CRONICACRONICA

““CHIRURGICAL”CHIRURGICAL”

ABCES ABCES PULMONARPULMONAR

IN FAZA IN FAZA CRONICACRONICA

““CHIRURGICAL”CHIRURGICAL”

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PNEUMONII INTERSTITIALE, ATIPICEPNEUMONII INTERSTITIALE, ATIPICEEtiologieEtiologie:-virusuri:-influenzae(gripa!),paragripale,adenovirus,respirat.:-virusuri:-influenzae(gripa!),paragripale,adenovirus,respirat.

sincitial,,myxovirus,mycoplasma pneumoniae (ag.EATON),v.rujeolic,sincitial,,myxovirus,mycoplasma pneumoniae (ag.EATON),v.rujeolic,

bacil pertusis (tuse convulsiva),Ricketsia Burnetti,ornitoza,psittacoza…bacil pertusis (tuse convulsiva),Ricketsia Burnetti,ornitoza,psittacoza…

Aspecte RxAspecte Rx::

--infiltrat hiliobazal:infiltrat hiliobazal: gripal Dittmar/Rupert gripal Dittmar/Rupert

- ”aripi fluture”perihilar;- ”aripi fluture”perihilar;

- reticulogranitat, noduli miliari acinari(ateleczii acinare);- reticulogranitat, noduli miliari acinari(ateleczii acinare);

- reactii pleurale discrete- reactii pleurale discrete

ComplicatiiComplicatii:-:-bronhopneumonie,pneumonie,pleurezii bronhopneumonie,pneumonie,pleurezii mici.mici.

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PNEUMONIE INTERSTITIALA:GRIPAPNEUMONIE INTERSTITIALA:GRIPAPNEUMONIE INTERSTITIALA:GRIPAPNEUMONIE INTERSTITIALA:GRIPA

TRIUNGHIUL DITTMAR & RUPPERTTRIUNGHIUL DITTMAR & RUPPERT

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EtiologieEtiologie::

Bacil Koch (BK);cale contaminare:aeriana(Flüge)Bacil Koch (BK);cale contaminare:aeriana(Flüge)

CLASIFICARE:CLASIFICARE:

II.-.-Tuberculoza primara(primo infectia);Tuberculoza primara(primo infectia);

II.-Tuberculoza secundara (ftizia)II.-Tuberculoza secundara (ftizia)

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Tuberculoza primară

complexul primar◦ afectul primar◦ limfangita tuberculoasă ◦ adenopatia satelită

adenopatie hilară pleurezie serofibrinoasă unilaterală tuberculoza primară miliară

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COMPLEX PRIMAR TUBERCULOSCOMPLEX PRIMAR TUBERCULOS

AFECTAFECT

LIMFANGITALIMFANGITA

ADENITAADENITA

RANCKERANCKE

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COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: periadenita periadenita

COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: periadenita periadenita

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COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: diseminarea hematogena= miliara tbcdiseminarea hematogena= miliara tbc

COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: diseminarea hematogena= miliara tbcdiseminarea hematogena= miliara tbc

ADENITAADENITA

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ADENITAADENITA

COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: pneumonia cazeoasa

COMPLEX PRIMAR TBC COMPLICAT:COMPLEX PRIMAR TBC COMPLICAT: pneumonia cazeoasa

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1) Noduli fibrosi apico-subclaviculari1) Noduli fibrosi apico-subclaviculari

2) Infiltratul precoce subclavicular2) Infiltratul precoce subclavicular

3) CAVERNA

• recenta

• elastica

• scleroasa

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NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI !! !!NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI NODULI FIBROSI APICALI =>POTENTIAL FTIZIOGENI !! !!

Infiltrat Infiltrat precoceprecoce

gglggl

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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

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TUBERCULOM APICALTUBERCULOM APICALTUBERCULOM APICALTUBERCULOM APICAL

Tomografie planaTomografie planaTomografie planaTomografie plana

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DEBUT AL FTIZIEI ADULTULUI=CAVERNA..DEBUT AL FTIZIEI ADULTULUI=CAVERNA..DEBUT AL FTIZIEI ADULTULUI=CAVERNA..DEBUT AL FTIZIEI ADULTULUI=CAVERNA..

TUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATomografie planaTomografie plana

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TBC CAZEOASA -CAVITARATBC CAZEOASA -CAVITARA

TUBERCULOMULTUBERCULOMUL

TBC FIBROASATBC FIBROASA

TBC HIPERCRONICA TBC HIPERCRONICA

COMPLICATII/SECHELE COMPLICATII/SECHELE

- HEMOPTIZIA;- HEMOPTIZIA;

- FIBROTORAX;- FIBROTORAX;

- CORD PULMONAR CRONIC;- CORD PULMONAR CRONIC;

- AMILOIDOZA etc.- AMILOIDOZA etc.

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FTIZIE: CAVERNA GIGANTAFTIZIE: CAVERNA GIGANTAFTIZIE: CAVERNA GIGANTAFTIZIE: CAVERNA GIGANTA

Diseminare controlaterala

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TUBERCULOZA EXTENSIVA CAZEOASA TUBERCULOZA EXTENSIVA CAZEOASA

-Sisteme de caverne-Sisteme de caverne

-pneumonie cazeoasa lob inf.-pneumonie cazeoasa lob inf.

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TUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARATUBERCULOZA CAZEOASA CAVITARA

Caverne+infiltrate+fibrozaCaverne+infiltrate+fibroza

Tomografie planaTomografie planaTomografie planaTomografie plana

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FTIZIE; PNEUMONIE CAZEOASA CAVITARAFTIZIE; PNEUMONIE CAZEOASA CAVITARAFTIZIE; PNEUMONIE CAZEOASA CAVITARAFTIZIE; PNEUMONIE CAZEOASA CAVITARA

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FTIZIE:DISEMINARE BRONHOPNEUMONICAFTIZIE:DISEMINARE BRONHOPNEUMONICA

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FTIZIEFTIZIE:DISEMINARE MILIARA IN:DISEMINARE MILIARA IN

TUBERCULOZA SECUNDARA TUBERCULOZA SECUNDARA

FTIZIEFTIZIE:DISEMINARE MILIARA IN:DISEMINARE MILIARA IN

TUBERCULOZA SECUNDARA TUBERCULOZA SECUNDARA

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Etiologie:Taenia equinococus

CHP NECOMPLICAT:CHP NECOMPLICAT:-macronodul opac gr.II-III;contur net-macronodul opac gr.II-III;contur net

(“tras cu compasul”),;”plasticitate” respiratorie;compresibil pe (“tras cu compasul”),;”plasticitate” respiratorie;compresibil pe plan dur(diafragm,coaste,cord).plan dur(diafragm,coaste,cord).

Dg.dif.=Dg.dif.=cancer periferic nodular. (CT,echografie).cancer periferic nodular. (CT,echografie).

CHP COMPLICAT:CHP COMPLICAT:--

a)a)Fisurat: Fisurat: comunicare bronsica=>semn MORQUIO (decolarea comunicare bronsica=>semn MORQUIO (decolarea membranelor, semiluna aerica);membranelor, semiluna aerica);

b)b)Rupt:Rupt:imag.hidro-aerica, nivel lichidian ondulat, membrane retinuteimag.hidro-aerica, nivel lichidian ondulat, membrane retinute

3)Diseminat:3)Diseminat:-hidatidoza secundara (macronoduli bilaterali)-hidatidoza secundara (macronoduli bilaterali)

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CHIST HIDATIC NECOMPLICATCHIST HIDATIC NECOMPLICAT

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Chist hidaticChist hidatic

complicat:complicat:

fisurareafisurarea

Chist hidaticChist hidatic

complicat:complicat:

fisurareafisurarea

SEMNUL SEMILUNEI AERICE

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CHIST HIDATIC COMPLICAT:CHIST HIDATIC COMPLICAT:

RUPTURA CHISTULUIRUPTURA CHISTULUI

CHIST HIDATIC COMPLICAT:CHIST HIDATIC COMPLICAT:

RUPTURA CHISTULUIRUPTURA CHISTULUI

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CHISTURICHISTURI

HIDATICEHIDATICE

MULTIPLEMULTIPLE

CHISTURICHISTURI

HIDATICEHIDATICE

MULTIPLEMULTIPLE

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Cea mai frecventa localizare;locul 1 mortalitate..!! FUMATUL!!

Histopatologie:Histopatologie:-epitelial epidermoid(squamos);-epitelial epidermoid(squamos);

adenocarcinom; celule mici ; sarcom.adenocarcinom; celule mici ; sarcom.

Anatomo-radiologic:Anatomo-radiologic:-bronsii mari (central)-bronsii mari (central)

-bronsii mici (periferic)-bronsii mici (periferic)

-alveolar (rarissim).-alveolar (rarissim).

Sediul fata de lumenSediul fata de lumen:-endobronsic==>atelectazie;:-endobronsic==>atelectazie;

-exobronsic ===>”iceberg”-exobronsic ===>”iceberg”

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1)1)EVIDENTIAZA TUMORAEVIDENTIAZA TUMORA:-Rx.standard,bronhografia,CT.:-Rx.standard,bronhografia,CT.

Aspecte: -Aspecte: -cancer hilar(central) cancer hilar(central) endobronsic=>atelectazieendobronsic=>atelectazie (segment,lob,pulmon);(segment,lob,pulmon); bronhografie: bronhografie: stenoze, amputatiistenoze, amputatii

-cancer hilar (central) exobronsic=>nodul -cancer hilar (central) exobronsic=>nodul opacopac

hilar + prelungiri radiare=“krebs füsse”(picioare hilar + prelungiri radiare=“krebs füsse”(picioare crab)crab) -cancer periferic,nodular=>nodul opac -cancer periferic,nodular=>nodul opac gr.II-gr.II-III, contur neregulat (prelungiri.),intensitate III, contur neregulat (prelungiri.),intensitate mare;mare;

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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

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CANCER ENDOBRONSICCANCER ENDOBRONSIC

Obstructia bronsiei primitive:ATELECTAZIE TOTALA Obstructia bronsiei primitive:ATELECTAZIE TOTALA

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CANCER EXOBRONSIC-CANCER EXOBRONSIC-

““MASIV AL HILULUI”MASIV AL HILULUI”

“Krebs füsse”

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CANCER NODULAR PERIFERICCANCER NODULAR PERIFERIC

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CANCER CANCER

NODULARNODULAR

PERIFERICPERIFERIC

Computer tomografie:Computer tomografie:

A).fereastra pulmon;A).fereastra pulmon;

B).fereastra mediastinB).fereastra mediastin

AA

BB

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2)2)APRECIAZA EXTENSIA LOCO-REGIONALAAPRECIAZA EXTENSIA LOCO-REGIONALA

Metode:Metode:--tomogr.US ,CT,cavografia,art.pulmonara,IRMN.tomogr.US ,CT,cavografia,art.pulmonara,IRMN.

Aspecte:Aspecte:-extensia mediastinala=>adenopatie,sten/tromb VCS;-extensia mediastinala=>adenopatie,sten/tromb VCS;

-extensia parietala=>apex=>Sd.Pancoast-Tobias;-extensia parietala=>apex=>Sd.Pancoast-Tobias;

-extensia lobara=>cancer lobar (“lobita carcinomat”)-extensia lobara=>cancer lobar (“lobita carcinomat”)

-invazie pericard=>pericardita=>-invazie pericard=>pericardita=>eco-cardiografia !eco-cardiografia !3)3)EVIDENTIAZA COMPLICATIILEEVIDENTIAZA COMPLICATIILE -necroza=>excavare=>suprainfectia;-necroza=>excavare=>suprainfectia; -invazia costala,pleurala-invazia costala,pleurala

4)4)DECELEAZA METASTAZELEDECELEAZA METASTAZELE

-OS=>scintigr.Tc99;CREIER=>IRMN,CT;FICAT,SR=>US-OS=>scintigr.Tc99;CREIER=>IRMN,CT;FICAT,SR=>US

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CANCER EXTINS LOBARCANCER EXTINS LOBAR

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CANCER BRONHO-PULMONAR:extensie parietalaCANCER BRONHO-PULMONAR:extensie parietala

Sd.PANCOAST-TOBIASSd.PANCOAST-TOBIAS

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CANCER BRONHO-PULMONARCANCER BRONHO-PULMONAR

ApreciereaAprecierea

extensieiextensiei

mediastinalemediastinale

prin CTprin CT

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CAI DE PROVENIENTA:CAI DE PROVENIENTA:

11))HEMATOGENAHEMATOGENA=> => noduli opaci gr.II-III, diseminatinoduli opaci gr.II-III, diseminati

anarhic, bilateral, inegali; nu conflueaza; contur net, forma anarhic, bilateral, inegali; nu conflueaza; contur net, forma rotunda (“lansare de baloane”..). rotunda (“lansare de baloane”..). Cauta: Cauta: cancercancerprimitiv teritoriul cav: san, testicul, rinichi, os, prostata.primitiv teritoriul cav: san, testicul, rinichi, os, prostata.

2)2)LIMFATICALIMFATICA=>=> diseminare peribonhovasculara/interstitiala diseminare peribonhovasculara/interstitiala parenchimatoasa: cordoane,micronoduli perihilar/hiliobazal parenchimatoasa: cordoane,micronoduli perihilar/hiliobazal bilat;asociaza pleurezie. bilat;asociaza pleurezie. CautaCauta:san:san, , pancreas, stomac, etc.pancreas, stomac, etc.3)3)MIXTA:-carcinomatoza “miliara”:MIXTA:-carcinomatoza “miliara”:-diseminare ininterstitiu, limfatic+hematogen: micronoduli diseminati pefond trabecular bilateral; tendinta la conglomerare.Cauta:Cauta:sin,tiroida,digestivsin,tiroida,digestivDg.difDg.dif.:bronhopneum.(1,3),hidatidoza(1),miliara tbc(3);.:bronhopneum.(1,3),hidatidoza(1),miliara tbc(3); -silicoza,viroze,colagenoze (2)-silicoza,viroze,colagenoze (2)

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METASTAZE PULMONARE TIP HEMATOGENMETASTAZE PULMONARE TIP HEMATOGEN

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METASTAZE PULMONARE TIP LIMFATICMETASTAZE PULMONARE TIP LIMFATIC

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1)1)PLEUREZII:PLEUREZII:--TranssudatTranssudat=>insufic.cardiaca.=>insufic.cardiaca.

--ExsudatExsudat=>inflamator,neoplazii etc.=>inflamator,neoplazii etc.A. A. PLEUREZIA MARII CAVITATI (PLEUREZIA MARII CAVITATI (mica,medie,mare,masiva) mica,medie,mare,masiva) Rx.:Rx.:opacitate omogena decliva gravitational dependenta; opacitate omogena decliva gravitational dependenta;

curba curba DamoiseauDamoiseau.

B. B. PLEUREZII INCHISTATE (PLEUREZII INCHISTATE (scizurala orizontala,oblica) scizurala orizontala,oblica)

Rx: Rx: -opacitate ovoida, fuziforma;-opacitate ovoida, fuziforma;

- diafragmatica: ascensionare diafragm; - diafragmatica: ascensionare diafragm; - mediastinala:largire in banda, - mediastinala:largire in banda,

- axilara:banda opaca paralela cu peretele axilar;- axilara:banda opaca paralela cu peretele axilar;

C. C. SECHELE PLEURETICE=SECHELE PLEURETICE=PAHIPLEURITE:PAHIPLEURITE:

-fibroase,fibrocalcare=>placarde,”platosa”,”cuirasa”.-fibroase,fibrocalcare=>placarde,”platosa”,”cuirasa”.

Rx.: Rx.: opacitati in banda, calcif.amorfe, retractii costale,opacitati in banda, calcif.amorfe, retractii costale,

” ”corturi”diafragcorturi”diafrag matice, simfize/imobilizare diafragmatica, matice, simfize/imobilizare diafragmatica,

deviere mediastin, coloana vertebraladeviere mediastin, coloana vertebrala..

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PLEUREZIA MARII CAVITATI:cantitate mica (A);PLEUREZIA MARII CAVITATI:cantitate mica (A);cantitate mare (B)cantitate mare (B)

PLEUREZIA MARII CAVITATI:cantitate mica (A);PLEUREZIA MARII CAVITATI:cantitate mica (A);cantitate mare (B)cantitate mare (B)

A B

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PLEUREZIA MARII CAVITATIPLEUREZIA MARII CAVITATI

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PLEUREZIIPLEUREZII

INCHISTATEINCHISTATE

INTERLOBARINTERLOBAR

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PLEUREZII INCHISTATE DIAFRAGMATICPLEUREZII INCHISTATE DIAFRAGMATIC

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PLEUREZIIPLEUREZII

INCHISTATE:INCHISTATE:

PLEUREZIAPLEUREZIA

MEDIASTINALAMEDIASTINALA

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SECHELE POST-PLEUREZIESECHELE POST-PLEUREZIE

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PAHIPLEURITA CALCARAPAHIPLEURITA CALCARA

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2)2)PNEUMOTORAX PNEUMOTORAX TOTAL/PARTIAL TOTAL/PARTIAL

Etiologie: Etiologie: spontan (astm !), accidental (trauma), spontan (astm !), accidental (trauma), iatrogen=>Dg & terapeutic. iatrogen=>Dg & terapeutic.

Tipuri: Tipuri: --endogenendogen (bula emf.,caverna); (bula emf.,caverna); exogenexogen=> plaga, => plaga, fracturi costale; fracturi costale; iatrogen (iatrogen (acc.punctie,dg/terap).acc.punctie,dg/terap).

Tipuri anat/radiologice:Tipuri anat/radiologice:-in pleura libera=>colaps la hil;-in pleura libera=>colaps la hil;

-in pleura simfizata=>colaps limitat-in pleura simfizata=>colaps limitat

Dg.Rx:Dg.Rx:- hipertransparenta cu absenta desenului pulmonar;- hipertransparenta cu absenta desenului pulmonar;

-linia bordanta pleurala viscerala;-linia bordanta pleurala viscerala;

-bont pulmonar colabat la hil, opac;-bont pulmonar colabat la hil, opac;

COMPLICATII:COMPLICATII:-hidro-pneumotorax-hidro-pneumotorax

-pio/hemo-pneumotorax.-pio/hemo-pneumotorax.

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PNEUMOTORAX HIDRO-PNEUMOTORAXPNEUMOTORAX HIDRO-PNEUMOTORAX

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Histopatologie:Histopatologie:-Endo/mezoteliom;sarcom;metastaze.-Endo/mezoteliom;sarcom;metastaze.

SEMNE RADIOLOGICESEMNE RADIOLOGICE :-noduli opaci marginali + :-noduli opaci marginali +

-epansament pleural variabil,-epansament pleural variabil,

hemoragic;hemoragic;

Dg.dificil CT;ecografie;PLEUROSCOPIE & biopsie;Dg.dificil CT;ecografie;PLEUROSCOPIE & biopsie;

PUNCTIE-BIOPSIE ghidata imagisticPUNCTIE-BIOPSIE ghidata imagistic

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TUMORA PLEURALA:MEZOTELIOMTUMORA PLEURALA:MEZOTELIOM

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C O R D U L SI VASELE MARI

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NEINVAZIVE

•US+Doppler color: duplex, triplex mod;”stress-Echo software”;

•RADIOGRAFIA standard => teleradio./fluoroscopie

• ANGIOCORONAROGRAFIE CT

•IRMN=>>cine,”Real time”; incidente multiple,reconstructii 3D;

•SCINTIGRAFIE

INVAZIVE

•CATETERISM + ANGIOGRAFIE+ OXIMETRIE+ PRESIUNI•angiocardiografie globala; levo-cardiograma(VStg);

•coronarografie selectiva;

•Digital Subtraction Angiography(DSA).

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MODIFICARI VOLUMETRICE1)HIPERTROFIA ATRIU STING: fluoroOAD+BariuEsofag

•Rg.PA=>contur concentric dublu,”festonat”,inversat;

bifurcatie traheala prin ascensiunea bronsiei pr.stg.;

•golful pulmonarei=rectiliniu sau convex.

2)HIPERTROFIA VENTR.STG:fluoro.OAS+Ba-Esofag;

•Radiografie PA=> longitudinal & transversal;

•alungire/rotunjire arc inferior stg.;infundare in diafragm;

•Radiogr.OAS-arc inferior-posterior X coloana vertebrala..

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CORD MITRAL:ATRIUL STING ,VIZIBIL MARIT

ASASASAS

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CORD AORTIC:MARIRE A VENTRICULULUI STING

SI ECTAZIE AORTICA IN INSUFICIENTA AORTICA

PA OAS

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MODIFICARI VOLUMETRICE

3)HIPERTROFIA DE ATRIU DREPT(AD)

•Rg.PA=>marire/bombare arc inferior drept=>=>dreapta;

•Rg.OAD=>bombare arc inf/posterior(pe diafragm);amprenta pe esofag baritat,inferior;obturare spatiu clar retrocardiac.

3)HIPERTROFIA DE VENTRICUL DREPT(VD).

•Rg.PA=> transversal;bombeaza arc inf.stg.;ridica vf.cord= “cord in sabot”;bombeaza arc inf .dr.:”impinge “AD;golf pulm. convex;

•Rg.OAD/OAS=>infundibul Art.Pulm. marit;obturare sp.clar retrosternal

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MODIFICARI VOLUMETRICE

5)HIPERTROFIA GLOBALA

a)Cardiomegalia:arcuri & unghiuri cardiofrenice pastrate; volum global marit;pulmon cardiac;

b)Pericardita:unghiuri cardiofrenice sterse,obtuze,arcuri disparute;pulmon: NORMAL sau staza venoasa (tamponada)

fluoroscopic:pulsatii atenuate/disparute;dg.dif.:ECOGRAFIC

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CALCIFICARI CARDIACE

1)ORIFICIALE:-fluoro:Ao= misc oblice;Mitrala=misc oriz.

-Pozitia in incid.lat:aortice=sup/post;mitrale=inferior/ant.

2)AORTICE PARIETALE:ateromatoza,anevrisme;

3)PERICARDICE-pericardita calcara;

4)MIOCARDICE:-infarct;anevrism;mixom;

5)CORONARIENE:ateromatoza;

OPACITATI ARTIFICIALEProteze valvulare metalice;proteze vasculare endoluminale

metalice(coronare);sonde stimulare intracardiaca/pacemaker

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OPACITATI METALICE “IATROGENE”

Proteza valvularaProteza valvulara PacemakerPacemaker

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I.STENOZA MITRALA

II.INSUFICIENTA MITRALA

IV.STENOZA AORTICA

V.INSUFICIENTA AORTICA

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Rx.=>CORD MITRAL: AS ;

BaEsof.OAD;

golf AP convex;

VS;

buton aortic ;

=>PULMON:-vene dilatate=>staza=> rezist.perif.=>

-spasm capilar(baraj II)=>hipertr.V.Dr.

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CORD MITRAL:ATRIUL STING ,VIZIBILMARIT

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HEMODINAMICA:reflux sistolic VS=>AS(“sînge pendulant”)=> hipertrofie VS+AS=>stază pulmonara=>Hipertrofie VDr.

Rx: volum AS;

volum VS;

expansiune sistolica AS= regurgitarea sistolica a Bariului in esofag (OAD);

CATETERISM VS & LEVOCARDIOGRAMA:-injectia in VS opacifiaza sincron aorta si prin contrast refluat- AS.

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CORD MITRAL-”BOVIN”:BOALA MITRALA

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VALVULOPATIE MITRALA (BOALA) DECOMPENSATA

EDEM PULMONARLinii KERLEY B

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Clasificare;subvalvulara,valvulara,supravalvulara(coarctatia)

Hemodinamic:baraj vidare sistolica a VS=> VS;efect “jet”

post-stenotic (COANDĂ)=>ectazie fuziforma AO ascendenta

Rx: - hipertrofie VS;

- AO asc.ectaziata/buton AO sters

-± calcificari valvulare;

CATETERISM:-dificil (stenoza);gradient presional VS/AO.

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MORFOLOGIC: valve béante, incongruente, inel larg;

HEMODINAMIC: -singe regurgitat AO=>VS(pendulant);insuf. Mitrala functionala prin marirea VS (tardiv)

Rx:- marire VS;

- AO amplu pulsatila,ectaziata,batanta;

-golf adincit=>”cord aortic”;

CATETERISM aortic & angio: -injectia in AO supravalvular arata “caderea” contrastului, in diastola ventriculara, in VS.

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CORD TIP AORTIC:INSUFICIENTA AORTICA

VSVSVS

OASOASPAPA

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INSUFICIENTA AORTICA ATEROMATOASA

RAD.STANDARD ANGIO-RMNANGIO-RMN

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PERICARDITE LICHIDIENE:

-EXSUDATIVE:-virale,tbc,reumatice;

-TRANSSUDATIVE:-neoplazica,uremica etc.

SEMNE Rx:

-stergerea sin.cardiofrenice;

-cord mare,”linistit”,pulsatii reduse;

-forma triunghiulara;

-arcuri sterse;

-migrare a lichidului spre mediastin =>decubit;

-scurtarea pediculului vascular al siluetei cardio-vasc;

-aspect “in carafa”;

-plamin normal sau stazic (in valvulopatii)

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PERICARDITA EXSUDATIVA PE CORD PATOLOGIC

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PERICARDITA EXSUDATIVA: A)ortostatism;B)decubit

AA BB

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PNEUMOPERICARD

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Sinonim=PERICARDITE FIBROASE

CONCRETIO CORDIS: simfiza pericardica intre foitele int/ext.;

APECT Rx: -pericardul ingrosat se calcifica(“pericardita calcara)

si se produc imagini “in dale de pavaj”,”in zale”(cuirasa=“panzer

herz”), arciforme -”in coaja de ou”.Dg.facil rad.in incid.oblice,lat.

ACRETIO CORDIS:simfiza pleuro-pericardica.

ASPECT Rx: -cordul poate avea dimensiuni normale, dar contur

modificat: dintat,festonat,”in corturi” pleuropericardice, stergere a sin.cardiofrenice; cord “fixat” la stern:in sistola, stern tras la cord;in inspir -peretele toracic tras spre placardul pericardic=>semnul WENKEBACH.

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PERICARDITA CONSTRICTIVA FIBRO-CALCARA

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PERICARDITA CONSTRICTIVA FIBRO-CALCARA

CONCRETIO & ACRETIO CORDISCONCRETIO & ACRETIO CORDIS


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