3. sindromul alveolar - seria 7seria7.weebly.com/uploads/4/0/8/5/4085189/curs_3.pdf · 11 caz...
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3. Sindromul alveolar
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Ce este sindromul alveolar?
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• Totalitatea semnelor radiologice apărute prin înlocuirea aerului alveolar cu un conţinut alveolar fluid.
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Semnele radiologice ale sindromului alveolar
• Opacitate
• Sistematizare lobară sau segmentară
• Intensitate „hidrică“ (mare), maximă în centrul opacităţii şi mai redusă la periferie
• Contururi şterse (până la interfaţa cu o scizură - unde conturul devine net);
• Structură omogenă;
• Bronhografie aerică în opacitate;
• Evoluţia rapidă.
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Caz particular de S. alveolar:Edemul pulmonar acut (EPA)
• Aceleaşi caractere cu opacitatea alveolară din consolidarea alveolară, dar:
• NU sistematizare;
• Contururi difuze;
• Distribuţie predominent perihilară;
• Context clinic şi anamnestic evocator.
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4. Sindromul interstiţial
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La ce se referă S. interstiţial?
• Ţesutul interstiţial pulmonar = „scheletul“ conjunctiv ce asigură susţinerea arhitectonicii pulmonare;
• 3 compartimente:
• peribronhovascular;
• interlobular;
• parieto-alveolar.
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Ce este S. interstiţial?
• Totalitatea semnelor radiologice ce traduc îngroşarea ţesutului interstiţial:
• 2 aspecte:
• creşterea grosimii benzilor interstiţiale normal vizibile;
• apariţia vizibilităţii interstiţiului acolo unde nu se identifică normal:• benzi;
• micronoduli.
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Semiologia sindromului interstiţial• Opacitate:
• Benzi;
• Micronoduli;
• Imagini liniare:
• Linii septale (Kerley);
• Benzi hilifuge;
• Imagini reticulare şi areolare;
• Imagini micronodulare:
• Micronodulii interstiţiali;
• Miliara;
• Imaginea de geam mat.
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Comparaţie opacităţi interstiţiale/alveolare
+)%- AU MARGINI BINE TRASATE% - AU EVOLUTIE LENTA
(-)%- NU SUNT CONFLUENTE% - NU SUNT SISTEMATIZATE% - NU DAU BRONHOGRAFIE AERICA
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5. Sindromul bronşic
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Ce este S. bronşic?
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• Totalitatea semnelor radiologice care reflectă afectarea bronşiilor
• perete;
• lumen.
• Semne directe:
• vizualizare propriu-zisă a anormalităţilor bronşice;
• Semne indirecte:
• modificări pulmonare generate de obstrucţia bronşică.
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Semnele directe ale S. bronşic
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1. Îngroşarea pereţilor / lumen gol:
• imaginea de „şină de tramvai“;
• imaginea „în ochelar“;
2. Umplerea lumenului bronşic (impactarea mucoidă):
• Benzi groase radiare hilifuge / opacităţi rotunde;
3. Bronşiectaziile (dilataţie specifică ± lumen plin)
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Semnele indirecte ale S. bronşic
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1. Atelectazia• obstructivă
• sistematizată;
• fără bronhografie aerică;
• retractilă;
• intensitate mare;
• omogenă;
• bine delimitată;
• hiperinflaţie compensatorie în plămânul aerat;
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Semnele indirecte ale S. bronşic (2)
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2. Emfizemul pulmonar localizat (cu aer captiv) - air trapping:• necesitatea unei Rg suplimentare: in expir;
3. Emfizemul pulmonar difuz
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6. Sindromul parenchimatos
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Ce este S. Parenchimatos?
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• Totalitatea semnelor Rg. ce caracterizează un proces al cărui caracter agresiv interesează toate clasele de ţesuturi indiferent de tipul acestora.
• Cauze:
• neoplazii primitive/secundare;
• procese inflamatorii destructive - abces.
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Tipuri de imagini întâlnite în S. Parenchimatos
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• Opacităţi:
• noduli / macronoduli:• unici / multipli;
• Imagini mixte:
• cavităţi
• Hipertransparenţe intraparenchimatoase
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Semnele generale ale imaginilor din S. parenchimatos
• Înconjurate de parenchim pulmonar indiferent de incidenţă;
• Când sunt periferice - racord în pantă bruscă cu peretele toracic / mediastinal
• Hipertransparenţe - reducere a numărului benzilor de desen pulmonar în interior.
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Nodulii/macronodulii solitari
• Dimensiunile (> 5 cm - malign);
• Conturul (benign/malign);
• Structura (intens calcificat - benign);
• Situarea (anterior - malign - criteriu nesigur)
• Leziunile asociate:
• infiltrat interstitial - inflamator;
• adenopatii hilare / liza costala - malign
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• Determinările secundare pulmonare
• Contur net;
• Forma; rotunzi;
• Structură omogenă;
• Intensitate mică/medie;
• Diseminare aleatorie bilaterală / predominent baze pulmonare;
• Fără calcificări
Nodulii pulmonari multipli diseminaţi
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• Cele mai frecvente:
• Abcesul pulmonar constituit;
• Caverna TBC;
• Aspergilomul;
• Chistul hidatic parţial evacuat.
Cavităţile
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• Ptr. caracterizarea cavităţilor - criteriul operant: peretele.
• versanţi:• intern/extern - regularitate / netitate;
• grosime.
Cavităţile - Atenţie
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• Contur:
• Net;
• Fin;
• Înconjurate de parenchim aerat;
• Avasculare (benzi reduse numeric în interior);
• Cel mai bine vizibile la CT;
• Pot avea conţinut mixt: hidroaeric
Hipertransparenţele
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• Cu aer captiv:
• Expir:• Creşterea diferenţei de transparenţă faţă de
plămânul adiacent;
• Volum nemodificat;
• Fără aer captiv:
• Hiperaeraţia compensatorie:• Expir - reducerea volumului
• Hipertransparenţa de cauză circulatorie
Hipertransparenţele localizate
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• Hipertransparenţa prin alterarea difuză a structurii parenchimului pulmonar
• Turtirea cupolelor diafragmatice;
• Reducerea amplitudinii mişcărilor respiratorii;
• Lărgirea spaţiilor intercostale;
• Orizontalizarea coastelor;
• Mărirea de volum a toracelui
• Lărgirea spaţiilor transparente retrosternal şi retrocardiac
• Redistribuţie vasculară către zonele parenchimatoase normale;
• Cord verticalizat, “mic”.
Hipertransparenţele difuze
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• Izolate:
• Granulomul inflamator;
• Tumoră benignă (hamartom)
• Încorporate în alte opacităţi;
• Difuze:
• Diseminate bilateral/unilateral.
Calcificările
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