curs respirator 2 patologie
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APARAT RESPIRATOR
Curs II
Semiologie radiologica
Sindroame pulmonare
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MODIFICARI DE FORMA A TORACELUI
Normal normostenic astenic (longilin) hiperstenic ( picnic)
Patologic cifo-scoliotic cifotic emfizematos paralitic torace in palnie torace in carena postchirurgical (toracoplastie, pneumonectomie), etc
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TORACE DEFORMAT
Cifo-scoliotic Cifotic
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PECTUS EXCAVATUM
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TORACE DE DIMENSIUNI CRESCUTE
Cresc toate diametrele cutiei toracice
Orizontalizarea arcurilor costale
Largirea spatiilor intercostale Aplatizarea diafragmelor
Cord verticalizat
o Cauza - emfizemul pulmonar
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MODIFICARI COSTALE
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MODIFICARI DIAFRAGNATICE FRECVENTE
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ASCENSIUNEA UNUI HEMIDIAFRAGM
Cauze Paralizie de nerv frenic (semnul Balantei)
Colectie inchistata in pleura diafragmatica → ecografie
Hepatomegalie tumorala sau nu / splenomegalie
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MOBILITATE REDUSA A UNUI DIAFRAGM
Diagnostico radioscopic
o doua radiografii - in inspir si in expir
Cauzeo aderente masive pleurale
o inflamatii supra- sau subdiafragmatice
o simfiza costo-diafragmatica↓
semnul miscarii in balama
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SIMFIZA COSTO-DIAFRAGMATICA
Miscare in balama
o inspir
o expir
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MODIFICARI PULMONARE
Opacitate = structura cu densitate↑ o Rx - negru
o Rgr - alb
Transparenta = structura cu densitate↓(aer)o Rx - alb
o
Rgr – negru
Imagine mixta = asocierea celor doua
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OPACITATI
Localizarea
o Regiunea pulmonara in PA
o Lobi, segmente, scizuri in PA si profil
o Semne radiologice in PA
Semnul unghiului de racordaj (Bernou)• unghi ascutit = apartenenta pulmonara
• unghi obtuz = apartenenta parietala
Semnul siluetei
• doua opacitati in contact isi sterg conturul la locul de contact
Semnul cervico-toracic
• opacitatea mediastinala care nu depaseste clavicula se afla în mediastinul anterior
• care depaseste clavicula este situata posterior
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OPACITATI
S. Bernou
S. siluetei
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OPACITATI
S. siluetei
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OPACITATI
Semnul bronhogramei aerice
sindrom de umplere alveolara (pneumonie indezvoltare )
Semnul alveologramei
sindrom de umplere alveolara (pneumonie inresorbtie)
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OPACITATI
S. brohnogramei aerice S. alveologramei
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OPACITATI
Brohnograma aerica
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OPACITATI - DESCRIERE
Localizare
Numar
Forma (cele nesistematizate)
Dimensiuni
Contur
o net, net si linear
o difuz (flu, imprecis)
o invadant
o regulat, neregulat
o
policiclic Structura = omogena / inomogena
Natura = opacitate, transparenta, imagine mixta
Intensitatea - >, <, = cordul (medie)
Raporturi
Dinamica
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OPACITATI - CONTUR
net si liniar (linie orizontala) net si linear
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OPACITATI - CONTUR
net invadant
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RAPORTURI CU ELEMENTELE INVECINATE
Nemodificate
Modificate prin
o tractiune (aderente)
o
aspiratie (atelectazia)o impingere (colectii pleurale mari, tumori, chiste aerice)
Volumul pulmonar si toracic
o nemodificat in pneumonieo micsorat (atelectazie)
o marit in emfizem sau tumori masive
Colectiile pleurale mari, scad vol. pulmonar şi cresc vol.
toracic
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EXEMPLIFICARE
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ROLUL CT
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HIPERTRANSPARENTE PULMONARE
Localizate sau difuze
Cu desen vascular sau fara desen vascular
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HIPERTRANSPARENTE PULMONARE
Localizate
o cu desen vascular = zone emfizematoase
o fara desen vascular = bine delimitate de un
perete propriu• chist aeric
• plaman polichistic
• bule de emfizem
• bronsiectazii chistice
• imagini cavitare = tumorale, TBC, abces evacuat,
pneumatocelul
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IMAGINILE CAVITARE
Sediul, numar, forma, dimensiuni
Conturul (peretele)
o Exterior
• (opac, fluu, extins = pneumonie abcedata )
• (cavitate in opacitate nodulara = tu. necrozata)
o Interior (anfractuos, neregulat = tu. necrozata)
Grosimea peretelui
o subtire = transparente circumscrise, de natura congenitala (chiste
aerice, plaman polichistic)o gros = cavitate formata in parenchim (caverna TBC, tu. cu centru
necrozat)
Continutul
o cavitate aerica sau mixta (cu lichid)
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PLAMAN POLICHISTIC
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CAVERNA TBC DRENATA
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HIPERTRANSPARENTE DIFUZE
Cu distensie aerica
Cu desen vascular, bilaterale
o Astm bronsic in criza
o Emfizemul pulmonar Cu desen vascular, unilaterale
o Stenoza bronsica pe bronsia principala cu ventil expirator
Cresc diametrele toracelui
Creste volumul pulmonar
Air trapping = scade diferenta inspir-expir
Modificari de artere pulmonare
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EMFIZEM PULMONAR
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HIPERTRANSPARENTE EXTINSE
Fara desen vascular
laterotoracic = pneumotorace
intrapulmonare = cavitati sau chiste aerice mari
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HIPERTRANSPARENTE EXTINSE
Chist aeric mare
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HIPERTRANSPARENTE EXTINSE
Emfizem bulos
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PNEUMOTORACELE
Hipertransparenta fara desen pulmonar
Localizat latero-toracic (cavitatea pleurala)
Delimitat medial de pleura viscerala a plamanului
adiacent Plamanul adiacent colabat spre hil
Delimitat lateral de pleura parietala
Poate fi si inchistat (exista simfiza pleurala)
Urgenta - pneumotoracele expansiv !!!
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PNEUMOTORACE
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PNEUMOTORACE POST-TRAUMATIC
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PNEUMOTORACE IN CANTITATE MICA
Decubit lateral
Rgr. expir
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PNEUMOTORACE “SUB TENSIUNE”
inspir expir
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IMAGINI MIXTE HIDRO-AERICE
opacitate lichidiana in partea inferioara
transparenta aerica in partea superioara
intre ele o linie orizontala, neta si liniara (NIVEL)
nivelul se mentine orizontal in orice pozitie apacentului
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IMAGINI HIDRO-AERICE IN TORACE
In plaman
o Abces partial evacuat
o Chist aeric suprainfectat
o Chistul hidatic partial evacuat
In cavitatea pleurala
o Hidropneumotoracele
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ABCESUL PULMONAR
Neevacuat = sdr. de umplere alveolara
Evacuat partial = imagine hidro-aerica
Evacuat total = imagine cavitara (aerica)
Abces recent = perete gros, neregulat, flu conturat
Abces cu evolutie cronica = perete subtire +
calcificare parietala
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ABCES PULMONAR
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ABCES PULMONAR
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ABCES PULMONAR
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ABCES PULMONAR - CT
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CHISTUL HIDATIC
Ne-evacuat = opacitate nodulara omogena (lichidiana)
Evacuat partial = imag. hidro-aerica cu perete subtire + nivelorizontal + membrana ondulanta
Evacuat total = chist aeric cu o opacitate mica, ratatinatata,
situata in portiunea decliva
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CHIST HIDATIC
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SINDROAME RADIOLOGICE PULMONARE
S. de umplere alveolara
S. bronsic
S. interstitial
S. pleural
S. parietal
S. vascular
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SINDROM DE UMPLERE ALVEOLARA
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SINDROM DE UMPLERE ALVEOLARA
Dispare aerul alveolar din acini (zona de schimbgazos)
Alveolele sunt umplute cu
o Exudat - pneumonie , bronhopneumonieo Transudat – edem pulmonar
o Sange – infarct pulmonar, contuzie pulmonara
o Lichid de aspiratie - pneumonie de aspiratieo Celule – tumori pulmonare
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SINDROM DE UMPLERE ALVEOLARA
Aspect radiologic
o Opacitate pulmonara sistematizata sau nesistematizata(edemul pulmonar)
o Nu modifica volumul pulmonar si toracic
o Initial contur fluu –conflueaza rapid, in “pata de ulei” – in evolutie net si liniar delimitat de scizuri (pneumoniilobare, segmentare)
o Cu bronhograma si alveolograma aerica
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SINDROM DE UMPLERE ALVEOLARA
Tipuri de opacitati
Pneumonii - lobite, segmentite, subsegmentite
Bronhopneumonii - micronodular sau nodular
Edem pulmonar alveolar - aspect “in aripi de fluture”
Posthemoptizie, metastaze – miliar
Infarct pulmonar - opacitate sistematizata (triunghiulara)
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SINDROM DE UMPLERE ALVEOLARA
Pneumonie
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SINDROM DE UMPLERE ALVEOLARA
Pneumonie – perioada de stare
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SINDROM DE UMPLERE ALVEOLARA
Pneumonie
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SINDROM DE UMPLERE ALVEOLARA
Pneumonie - CT
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SINDROM DE UMPLERE ALVEOLARA
Bronho-pneumonie stafilococica
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SINDROM DE UMPLERE ALVEOLARA
Edem pulmonar alveolar
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SINDROM DE UMPLERE ALVEOLARA
Edem pulmonar alveolar - renal
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SINDROM DE UMPLERE ALVEOLARA
TBC miliar
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SINDROM DE UMPLERE ALVEOLARA
Aspect miliar pulmonar - candida
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SINDROM DE UMPLERE ALVEOLARA
Aspect miliar alveolar - metastaze
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SINDROMUL BRONSIC
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SINDROMUL BRONSIC
Ingrosare a peretilor bronsici
Stenoza bronsica
Obstructie bronsica - opacitati pulmonareretractile
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SINDROMUL BRONSIC
Ingrosare parietala bronsica
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SINDROMUL BRONSIC
Bronsite cronice
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SINDROMUL BRONSIC
Bronsiolita – sugari (etiologie virala)
o Hiperinflatie
o Pereti bronsici ingrosati
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SINDROMUL BRONSIC
Bronsiectazii
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MODIFICARI MEDIASTINALE
Marirea opacitatii mediastinale patologia cordului si vaselor mari
tumori mediastinale
adenopatii
Mediastin deplasat
aderente (pleurale, fibrotorace)
aspiratie (atelectazie pulmonara)
compresiune (colecţii pleurale mari)
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MODIFICARI MEDIASTINALE DINAMICE
Deplasarea mediastnului – stenoza bronsica
cu ventil inspirator cu ventil expirator
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MODIFICARI MEDIASTINALE DINAMICE
Semnul pendularii mediastinale
= stenoze bronsice mixte
Stenoza bronsica inspiratorie= atractia inspiratorie spre partea cu stenoza
Stenoza bronsica expiratorie= impingere expiratorie spre partea opusa stenozei
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TIPURI DE ATELECTAZIE
1. Obstructiva (resorbtiva)
2. Pasiva (colaps de natura pleurala)
3. Compresiva (hipotransparenta in jurul unui proces
expansiv)4. Cicatriceala (condensare + reducere a vol.
pulmonar - organizare fibroasa)
5. Adeziva (boala membranelor hialine la nounascut, pneumonita radica)
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ATELECTAZIA OBSTRUCTIVA
Semne directe
Opacitate sistematizata
Retractila – scizura invecinata concava Reduce volumul toracic si pulmonar
Delimitare neta si lineara prin scizuri
Forma de triunghi cu varful spre hil si baza lapleura
Nu are bronhograma si alveolograma
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ATELECTAZIA OBSTRUCTIVA
Semne indirecte
Ascensiunea diafragmului
Aspiratia mediastinului Modifica pozitia hilului pulmonar
Retractie costală
Expansiunea parenchimului pulmonar invecinat(emfizem compensator)
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ATELECTAZIE PLAMAN STANG
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ATELECTAZIE PLAMAN STANG
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ATELECTAZIE LOBARA - LSD
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ATELECTAZIE LOBARA - LSD
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ATELECTAZIE DE LOB SUPERIOR STANG
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ATELECTAZIE DE LOB INFERIOR DREPT
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SINDROM INTERSTITIAL
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SINDROM INTERSTITIAL
Ingrosarea tesutului interstitial prin
o Edem interstitial
o Proliferare anormala celulara sau tisulara
(fibroze, granulomatoze)
o Afectiuni interstitiale maligne (limfangita
carcinoamatoasa)
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SINDROM INTERSTITIAL
Aspectul radilogic
Topografia difuza
Nu sunt sistematizate
Contur net
Intensitate redusa
Nu sunt confluenteEvolutie lenta
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1 a,b = int.peribronho-vascular
2 = int. intralobular
(periacinar,perialveolar)
SINDROM INTERSTITIAL
3 = septe interlobulare
5 = int. subpleural
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SINDROM INTERSTITIAL
Forme radiologice
sticla mata - interstitiul parieto- alveolar
reticular - interstitiul perilobular si intralobular micronodular - interstitiul parieto-alveolar
reticulo-nodular
in “fagure de miere” (pseudomicropolichistic) -interstitiul perilobular si intralobular
liniar – interstitiul peribronhovascular si subpleural
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SINDROM INTERSTITIAL
Aspectul miliar / noduli interstitiali
o p – diam. 1,5 mm
o q/m – diam. 1,5 -3 mm (micronodulare)
o r/n – diam. 3-10 mm (nodulare)
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SINDROM INTERSTITIAL
Aspectul miliar / noduli interstitialio Silicoza
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SINDROM INTERSTITIAL
Aspectul miliar / noduli interstitialio Silicoza
SINDROM INTERSTITIAL
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SINDROM INTERSTITIAL
Aspectul de “sticla mata”
SINDROM INTERSTITIAL
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SINDROM INTERSTITIAL
Afectiuni cu sindrom interstitialo Colagenoze
o Histiocitoza X
o Sarcoidozao Fibroza pulmonara primitiva
o Pneumoconioze
o Pneumonia cu Pneumocystis cariniio etc
SINDROM INTERSTITIAL
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SINDROM INTERSTITIAL
Limfangita carcinomatoasa
SINDROM INTERSTITIAL
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SINDROM INTERSTITIAL
Limfangita carcinomatoasa
SINDROM INTERSTITIAL
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SINDROM INTERSTITIAL
Limfangita carcinomatoasa – aspect reticular
SINDROM INTERSTITIAL
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SINDROM INTERSTITIAL
Edem interstitial
SINDROM INTERSTITIAL
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SINDROM INTERSTITIAL
Edem interstitial
SINDROM INTERSTITIAL
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SINDROM INTERSTITIAL
Fibroza chistica
SINDROM INTERSTITIAL
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SINDROM INTERSTITIAL
HR - CT
“sticla mata”
sarcoidoza
SINDROM INTERSTITIAL
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SINDROM INTERSTITIAL
HRCT – fibroza chistica
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SINDROM PLEURAL
SINDROMUL PLEURAL
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SINDROMUL PLEURAL
Acumularea de lichid in cavitatea pleurala
o pres. hidrostatica crescuta
o
pres. oncotica scazuta
o inflamatii
o tumori
SINDROMUL PLEURAL
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SINDROMUL PLEURAL
Fac parteo pleureziile exudative
o pneumotoracele
o hidropneumotoraceleo Calcificarile pleurale
o Tumori pleurale
PLEUREZIILE EXUDATIVE
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PLEUREZIILE EXUDATIVE
Libere - cantitate mica, medie, mare
Inchistate in
o marea cavitate
o scizuri
o supradiafragmatic
o pleura mediastinala
PLEUREZIILE EXUDATIVE RADIOLOGIC
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PLEUREZIILE EXUDATIVE - RADIOLOGIC
Libere - cantitate mica
o opacifierea sinusului costo-diafragmatic
o
contur fluu al diafragmuluio hipomobilitatea diafragmului
o colectia se misca concomitent cu diafragmul
o dg. diferential - simfiza costo-diafragmatica
PLEUREZIILE EXUDATIVE RADIOLOGIC
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PLEUREZIILE EXUDATIVE - RADIOLOGIC
Libere - cantitate medie
o opacitate bazala ce urca laterotoracic
o
delimitata de o linie concava, fluu delimitatao hipotransparenta plamanului adiacent
o opacitatea mobila cu pozitia
o nu are bronhograma sau alveolograma
PLEUREZIILE EXUDATIVE RADIOLOGIC
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PLEUREZIILE EXUDATIVE - RADIOLOGIC
Libere - cantitate mareo Opacitate mare
o Lichidul incorporeaza si varful
o Mediastinul impins in partea opusao Volum toracic crescut
o Aceleasi caractere
Opacitate masiva care nu impinge mediastinul=pleurezie + atelectazie
PLEUREZIILE EXUDATIVE RADIOLOGIC
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PLEUREZIILE EXUDATIVE - RADIOLOGIC
Bilaterala
PLEUREZIILE EXUDATIVE RADIOLOGIC
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PLEUREZIILE EXUDATIVE - RADIOLOGIC
Bilaterala
PLEUREZIILE RADIOLOGIC
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PLEUREZIILE - RADIOLOGIC
In cantitate mare – hemotorace post-traumatic
PLEUREZIILE EXUDATIVE - RADIOLOGIC
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PLEUREZIILE EXUDATIVE - RADIOLOGIC
In cantitate mare
PLEUREZIILE EXUDATIVE - RADIOLOGIC
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PLEUREZIILE EXUDATIVE - RADIOLOGIC
PLEUREZIILE EXUDATIVE - RADIOLOGIC
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PLEUREZIILE EXUDATIVE - RADIOLOGIC
Inchistata
Ziua 1 Ziua 5
PLEUREZIILE EXUDATIVE - RADIOLOGIC
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PLEUREZIILE EXUDATIVE - RADIOLOGIC
Inchistata
PLEUREZII - RADIOLOGIC
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PLEUREZII RADIOLOGIC
Empiem inchistat
PLEUREZII - RADIOLOGIC
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PLEUREZII RADIOLOGIC
Empiem inchistat
PLEUREZII - CT
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PLEUREZII CT
Empiem TBC
HIDRO-PNEUMO TORACE
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HIDRO PNEUMO TORACE
PAHIPLEURITA CALCARA
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PAHIPLEURITA CALCARA
PLACI AZBESTOZICE PLEURALE
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PLACI AZBESTOZICE PLEURALE
TUMORI PLEURALE
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TUMORI PLEURALE
PrimareMezotelioame
o fibros localizat = benign, rar, recidiveaza
o
difuz = malign, frecvent, liza costala, revarsatpleural
Tu secundare = metastaze
TUMORI PLEURALE
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TUMORI PLEURALE
Radiologico Opacitate hemisferica placata pe perete
o Nu se modifica la Valsalva –Müller
o Distrug arcurile costale
o Colectii pleurale asociateo Nu are semnul coafarii
Ecografia – ecogena
CT - densitate parenchimatoasa si/sau lichidiana(colectie pleurala) si depozite calcare
MEZOTELIOM
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MEZOTELIOM
MEZOTELIOM
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MEZOTELIOM
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SINDROM PARIETAL
SINDROM PARIETAL
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Semne radiologice pentru un procesexpansiv in peretele toracic
In afara foitelor pleurale
Cuprinde patologia
peretelui toracic
diafragmatica
mediastinala
TUMORI PARIETALE
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Dezvoltare spre interior / exterior
In toate incidentele nu poate fi disociata de perete
Opacitate net sau fluu delimitata in functie de incidenta
Afectare costala
Se misca cu coastele
Nu are bronhograma
Semnul coafarii parietale este prezent
SEMNUL COAFARII PLEURALE
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Pe rgr. tangente (oblice) la perete se vede
lizereul clar al grasimii extrapleurale
endotoracice
STRUCTURA PARIETALA
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1. M. intercostali2. Fascia endotoracica
3. Grasimea endotoracica
4. Pleura parietala
5. Pleura viscerala
SEMNUL COAFARII PLEURALE
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1. Pleura parietala si viscerala2. Grasimea endotoracica
3. Procesul expansiv
SINDROM PARIETAL
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Aspectul radiologic in functie de localizare
SINDROM PARIETAL
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Tumora parietala
SINDROM PARIETAL
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Osteocondrom de perete toracic
SINDROM PARIETAL
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Condrosarcom de perete toracic
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