Radio Imagistica pulmonara 2. Patologie pulmonara

PATOLOGIE PATOLOGIE PULMONARAPULMONARA

RADIO – IMAGISTICA-2

Rad/Imag-Iasi-2003

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

CHISTURICHISTURI

AERIENE:AERIENE:

MULTIPLE,MULTIPLE,

ABCEDATEABCEDATE

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 CRONICA: BRONSITA CRONICA: bronhografiibronhografii

BRONSITA DEFORMANTABRONSITA DEFORMANTA

Patologie bronsicaPatologie bronsicaULCERATII

“NISE” PARIETALE

EMFIZEM PULMONAR

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: “BRONSIECTAZIE: “ROZETA AMEUILLEROZETA AMEUILLE””

BROHOGRAFIE BROHOGRAFIE

BRONSII NORMALEBRONSII NORMALE BRONSIECTAZIEBRONSIECTAZIE

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 EXOBRONSIC-CANCER EXOBRONSIC-

““MASIV AL HILULUI”MASIV AL HILULUI”

“Krebs füsse”

CANCER NODULAR PERIFERICCANCER NODULAR PERIFERIC

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

CANCER EXTINS LOBARCANCER EXTINS LOBAR

Sindrom Pancoast - Tobias

Cancer bronhopulmonar periferic apical sting cu distructia arcurilor costale I - IV si a vertebrelor T1-T4

CANCER BRONHO-PULMONAR: CANCER BRONHO-PULMONAR: extenzie parietalaextenzie parietala

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

METASTAZE PULMONARE TIP HEMATOGENMETASTAZE PULMONARE TIP HEMATOGEN

METASTAZE PULMONARE TIP LIMFATICMETASTAZE PULMONARE TIP LIMFATIC

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 LOB MEDIUPNEUMONIE BACTERIANA LOB MEDIU

PNEUMONIE BACTERIANA LOB SUPERIORPNEUMONIE BACTERIANA LOB SUPERIOR

Segment axilarSegment axilar

PNEUMONIE BACTERIANA PLURISEGMENTARAPNEUMONIE BACTERIANA PLURISEGMENTARA

FOCARE PNEUMONICEFOCARE PNEUMONICE

MULTIPLEMULTIPLE

FOWLERFOWLER

LINGULALINGULA

PNEUMONIE BACTERIANA: PNEUMONIE BACTERIANA: diagnostic diferentialdiagnostic diferential

Pneumonie bacterianaPneumonie bacteriana Atelectazie:cancer endobronsicAtelectazie:cancer endobronsic

PNEUMONIE BACTERIANA PNEUMONIE BACTERIANA

BRONHOGRAMA AERICABRONHOGRAMA AERICA

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.

BRONHOPNEUMONIEBRONHOPNEUMONIE

BRONHOPNEUMONIEBRONHOPNEUMONIE

BRONHOPNEUMONIEBRONHOPNEUMONIE

FORMA PSEUDOLOBARAFORMA PSEUDOLOBARA

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 PULMONAR SECUNDAR PNEUMONIEIABCES PULMONAR SECUNDAR PNEUMONIEI

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

FTIZIE:DISEMINARE BRONHOPNEUMONICAFTIZIE:DISEMINARE BRONHOPNEUMONICA

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

ASPERGILOM - caverna tuberculoasa complicata micotic

Toracoplastie - metoda de tratament abandonata

CURS patol.toracica 3