cd leziuni elementare - pulmonar
DESCRIPTION
CD Leziuni Elementare - PulmonarTRANSCRIPT
![Page 1: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/1.jpg)
TORACE
![Page 2: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/2.jpg)
Sindrom PARIETAL
![Page 3: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/3.jpg)
Mamectomie unilaterala
Crestere difuza a transparentei unui hemitorace
FARA modificari de circulatie pulmonara si FARA hiperinflatie
** Se apreciaza prin comparatie cu hemitoracele opus **
![Page 4: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/4.jpg)
Calcificari de parti moi
![Page 5: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/5.jpg)
Cresterea localizata a grosimii peretelui toracic
6
4
1, 2
5
3
1 Contur net spre pulmon
2 Lizereu opac de delimitare spre pulmon (= pleura parietala)
3 Contur sters spre peretele toracic
4 Racord in panta lina
5 Vascularizatie normala vizibila pe aria opacitatii
± 6 Liza costala in vecinatate
![Page 6: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/6.jpg)
Emfizem subcutanat
Benzi radiotransparente in partile moi
Extindere in zone limitrofe:
- Dilacerare parti moi
± Pneumomediastin
Se poate asocia cu pneumotorax
![Page 7: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/7.jpg)
Modificari costale
Calcificari condrocostale
Malformatii costale
Coasta cervicala
![Page 8: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/8.jpg)
Modificari costale
Fracturi costale vechi (calus vicios)
Fractura costala recenta
Liza costala (maligna)
![Page 9: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/9.jpg)
Modificari ale diafragmului
Ascensiune hemidiafragm Boselura diafragmatica
![Page 10: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/10.jpg)
Sindrom PLEURAL
![Page 11: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/11.jpg)
Pleurezie libera in cantitate medie
Opacitate masiva omogena:
- Nesistematizata
- Variabila cu pozitia bolnavului
- De la o margine la cealalta a hemitoracelui indiferent de pozitia bolnavului
- Intensitate supracostala si maxima in portiunea cea mai decliva
- Contur superior sters, concav (curba Damoiseau radiologica)
- Racord in panta lina
- Sterge conturul organelor cu care vine in contact (diafragm, cord, perete toracic)
- Efect de masa
![Page 12: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/12.jpg)
Pleurezie masiva
Pleurezia masiva efect de masa:
- impinge cord, mediastin, diagrafm
- largeste spatiile intercostale
Atelectazia masiva (diagnostic diferential):
- tractioneaza cord, mediastin, diagrafm
- ingusteaza spatiile intercostale
![Page 13: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/13.jpg)
Pleurezie inchistata parietal
Opacitate masiva omogena:
- Nesistematizata
- NU variaza cu pozitia bolnavului
- Intensitate supracostala
- Contur net spre pulmon
- Racord in panta lina
![Page 14: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/14.jpg)
Pleurezie inchistata scizural
![Page 15: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/15.jpg)
Pneumotorax in cantitate medie
1
23
4 1 Hipertransparenta periferica total lipsita de desen pulmonar
2 Bontul pulmonar retractat central si caudal
3 Contur net dat de pleura viscerala
4 Mediastin in pozitie normala
![Page 16: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/16.jpg)
Pneumotorax compresiv (cu supapa)
® = mare urgenta!
Colabare completa a plulmonului
Mediastin deplasat contralateral
Diafragm – curbura inversa
Largirea spatiilor intercostale
Coaste orizontalizate
Aspect de torace “nelocuit”
![Page 17: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/17.jpg)
Hidro-pneumotorax
1 Pneumotorax
2 Nivel hidroaeric orizontal (si mobil cu pozitia bolnavului)
3 Bont pulmonar (deformat de aderente pleurale in aceasta imagine)
1
3
![Page 18: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/18.jpg)
Pahipleurita
Opacitate in banda care “dubleaza” conturul peretelui toracic si/sau mediastinului
± Pahiscizurite
± Simfiza unghi costo-frenic
Retractila:
- Ingusteaza spatiile intercostale
- Poate tractiona si mediastinul
“Pahipleurita apico-latero-bazala si mediastinala anterioara si posterioara dreapta, cu simfiza unghiului costo-frenic drept“
![Page 19: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/19.jpg)
Sindrom ALVEOLAR
![Page 20: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/20.jpg)
Pneumonie franca
Opacitate triunghiulara cu varful spre hil si baza spre periferie
Sistematizata la un segment sau lob
Contur net unde e limitata de o scizura, in rest contur sters
Intensitate supracostala
Bronhograma aerica in interior
![Page 21: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/21.jpg)
Pneumonie in constituire – nodulul alveolar
1
2
3
1 Micronoduli acinari (= leziunea alveolara elementara):
- Forma rotund-ovalara
- Contur sters
- Intensitate subcostala
- Tendinta la confluare (aglutinare in opacitati nodulare cu contur sters si aspect de “valatuci de fum”) (2)
…pana la opacitate masiva, de tip pneumonic (3)
![Page 22: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/22.jpg)
Edem Pulmonar Acut
Opacitati neregulate sau nodulare cu contur sters si aspect de “valatuci de fum”, care se extind perihilar si bazal bilateral “in aripi de fluture”, cu evolutie foarte rapida (ore)
![Page 23: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/23.jpg)
Sindrom INTERSTITIAL
![Page 24: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/24.jpg)
Micronodulii interstitiali
- Dimensiuni mici (cativa mm)
- Contur net
- Intensitate supracostala
- Indiferent cat ar fi de multi: NU conflueaza, NU sunt sistematizati si NU produc bronhograma aerica!
- Evolutie lenta (luni-ani)
- Adesea par situati la intersectia unor benzi de fibroza (aspect de “steluta”)
![Page 25: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/25.jpg)
Benzi de fibroza, imagini reticulare
Benzi de fibroza:
- Opacitati liniare
- Contur net
- Grosime aprox. uniforma
- Pot parea intersectate, dar NU se divid
Imagini Reticulare:
= aspectul de “plasa de pescuit” generat de multiple benzi fibroase fine care se intersecteaza anarhic
La intersectia benzilor pot exista micronoduli interstitiali
![Page 26: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/26.jpg)
Sindrom BRONSIC
![Page 27: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/27.jpg)
Bronsiectazii
1 Aspectul de “sina de tren”
2 Bronsiectazii (cavitati cu pereti subtiri, grupate in “buchet”)
3 Bronsiectazii suprainfectate (imagini mixte cu pereti subtiri si nivel hidroaeric)
1
2
3
![Page 28: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/28.jpg)
Atelectazie lobara
Opacitate trunghiulara sistematizata
Tractioneaza scizurile
FARA bronhograma aerica
![Page 29: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/29.jpg)
Atelectazie masiva
Opacitate masiva supracostala omogena
Ingusteaza spatiile intercostale
Tractioneaza traheea, mediastinul si cordul catre hemitoracele afectat
Hiperinflatie compensatorie a pulmonului contralateral (transparenta crescuta, desen vascular gracil)
![Page 30: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/30.jpg)
Sindrom CAVITAR
![Page 31: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/31.jpg)
Emfizem bulos
(imagini cavitare cu perete subtire)
![Page 32: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/32.jpg)
Pneumonie abcedata
Opacitate alveolara sistematizata lobar (pneumonie lobara, cu bronhograma aerica) care contine
o hipertransparenta cu contur net anfractuos si cu nivel hidro-aeric
![Page 33: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/33.jpg)
Caverna TBC activa
Imagine mixta cavitara:
- cu perete gros
- contur extern sters
- contur intern net, regulat
- nivel hidroaeric; lichid in cantitate mica (<1/2)
+ Bronhie de drenaj
![Page 34: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/34.jpg)
Caverna TBC veche
Imagine mixta cavitara:
- cu perete subtire
- contur net
± fibroza, pahipleurita in vecinatate ( = alte sechele TBC)
FARA nivel hidroaeric (goala)
FARA Bronhie de drenaj
![Page 35: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/35.jpg)
Tumora necrozata
Imagine mixta cavitara:
- cu perete gros
- contur extern sters
- contur intern neregulat sters
- nivel hidroaeric; lichid in cantitate Mare (>1/2)
FARA Bronhie de drenaj !
![Page 36: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/36.jpg)
Sindrom TUMORAL
![Page 37: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/37.jpg)
Adenopatie hilara bilaterala
Hiluri cu contur policiclic
![Page 38: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/38.jpg)
Chist Hidatic
Opacitate macronodulara cu:
- Contur net
- Intensitate supracostala (hidrica)
- Structura omogena
![Page 39: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/39.jpg)
Tumoreta Benigna
Opacitate macronodulara cu:
- Dimensiuni <4cm
- Contur net
- Intensitate supracostala
- Structura neomogena, cu calcificari in interior
![Page 40: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/40.jpg)
Tumora Maligna
Opacitate macronodulara cu:
- Dimensiuni >4cm
- Contur sters, neregulat
- Intensitate supracostala
- Structura neomogena
![Page 41: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/41.jpg)
Metastaze pulmonare
Multiple opacitati nodulare cu caractere radiologice similare:
- Diseminate in ambele hemitorace
- Contur net (!)
- Intensitate costala
- Structura omogena
Se pot suma prin proiectie, dar oricat de multe ar fi NU conflueaza !
![Page 42: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/42.jpg)
Metastaze pulmonare - Carcinomatoza
Multiple opacitati micronodulare cu caractere radiologice similare:
- Diseminate in ambele hemitorace
- Contur net
- Intensitate costala/subcostala
- Structura omogena
Se pot suma prin proiectie, dar oricat de multe ar fi NU conflueaza !
![Page 43: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/43.jpg)
Sindrom MEDIASTINAL
![Page 44: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/44.jpg)
Tumora mediastinala
Largeste opacitatea cardio-mediastinala
Sterge conturul mediastinului
Contur spre pulmon:
- net atata vreme cat este limitata de pleura (2)
- sters neregulat cand invadeaza pleura si apoi si pulmonul (3)
12 3
![Page 45: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/45.jpg)
Tumora pulmonara placata la mediastin - Semnul siluetei
1
2
1 NU sterge conturul mediastinului
2 Racord in unghi ascutit
![Page 46: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/46.jpg)
Tumora mediastinala – localizare
In mediastinul anterior
(NU depaseste cranial clavicula)
In mediastinul posterior
(se proiecteaza si cranial de clavicula)
![Page 47: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/47.jpg)
Sindroame CARDIACE
![Page 48: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/48.jpg)
Opacitate cadriopericardica global marita
cardiomiopatie dilatativa
1
2
3
Diametrul transvers al cordului > ½ din diametrul transvers maxim al toracelui (1+2>3)
Arcurile cordului si mediastinului sunt deformate, dar exista
![Page 49: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/49.jpg)
Opacitate cadriopericardica global marita
Pericardita lichidiana
21
3
Diametrul transvers al cordului > ½ din diametrul transvers maxim al toracelui (1+2>3)
Dispar arcurile cordului si mediastinului, aspect de “punga plina cu apa”
![Page 50: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/50.jpg)
Marire de AS
1 Arc suplimentar drept paralel sau secant cu arcul AD
2 Unghi carinar >90º
3 Arc suplimentar stang convex intre VS si TP = auricul stg
![Page 51: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/51.jpg)
Marire de VS - dilatatie
Arc VS alungit, deplasat spre stg
Apex “ingropat in diafragm”
Unghi cardio-frenic stg obtuz
![Page 52: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/52.jpg)
Marire de VS - hipertrofie
VS = “scurtat”
Apex supradiafragmatic si rotunjit
![Page 53: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/53.jpg)
Marire de VD
Bombare segment cranial al arcului inf stg.
Apex ascensionat supradiafragmatic
![Page 54: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/54.jpg)
Marire de AD
Arc AD bombat si deplasat spre dreapta cu >2cm de marginea corpilor vertebrali
![Page 55: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/55.jpg)
HTAP
1 O zonă centrală = pletora2 O zonă periferică = olighemie……………limita celor două zone este netă – aspect de “Hil Amputat”(intreruperea bruscă a benzilor opace, groase date de arterele pulmonare centrale dilatate)
+ Bombare trunchi AP (datorită hiperpresiunii)
1
2
![Page 56: CD Leziuni Elementare - Pulmonar](https://reader034.vdocuments.pub/reader034/viewer/2022050620/563db8c2550346aa9a96b081/html5/thumbnails/56.jpg)
Redistributie vasculara baze-varfuri