curs 6b cord anatomie tehnici
TRANSCRIPT
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CATEDRA DE RADIOLOGIE UMF Cluj-Napoca
EXAMINAREA RADIO – IMAGISTICAA CORDULUI
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TEHNICI DE INVESTIGATIE
ANATOMIE RADIO-IMAGISTICA
SDR. VASCULAR : caracteristici -- artere -- veneHTVP / HTAP / mixta
PATOLOGIE
RADIO-IMAGISTICA INIMII
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Metode de investigatieMetode de investigatie
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Metodele de investigaţie Metodele de investigaţie
ale aparatului cardio-vascularale aparatului cardio-vascular Metode conventionale:
- radiografia PA, TS, (OAS, OAD)
- radioscopia Metode imagistice :- ecocardiografia, (ETE, ecografia)- cateterismul cardiac- angiografia, coronarografia- CT multislice- IRM- scintigrafia cardiacă;- SPECT, PET*
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Metode – iradiante / neiradianteMetode – iradiante / neiradiante
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Metode – neiradiante / ecografia
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Metode/ Imagistica sectionala
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Metode / coronarografie
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Metode /Scintigrafia cardiaca – perfuzie miocardica
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Anatomie radio-imagistica cardio-vasculara
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Imaginea radiologica toracica normala PA,TS,Imaginea radiologica toracica normala PA,TS,(OAS,OAD)(OAS,OAD)
1. VCS2. AD3. VD4. Aorta5. AP6. AS7. VS8. Triunghiul aortei9. Fereastra pulmonarei
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Anatomie radiologica
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Anatomie radiologica PAAnatomie radiologica PA
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Anatomie radiologica PAAnatomie radiologica PA
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Imaginea cardiaca radiologica - PAImaginea cardiaca radiologica - PA
1. dimensiunea cordului in raport cu diafragmul
2. masurarea aortei dupa metoda Kreuzfuchs
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Imaginea cardiaca radiologica - PA Imaginea cardiaca radiologica - PA Indicele cardio-toracicIndicele cardio-toracic
T1+T2 = diametrul transvers cardiac
DT = diametrul transvers toracic
ICT=DTC/DT=0.48
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Anatomie radiologica TSAnatomie radiologica TS
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Anatomie radiologica TSAnatomie radiologica TS
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Anatomie radiologica TSAnatomie radiologica TS
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Anatomie radiologica OADAnatomie radiologica OAD
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Anatomie radiologica OADAnatomie radiologica OAD
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Anatomie radiologica OASAnatomie radiologica OAS
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Anatomie radiologica OASAnatomie radiologica OAS
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Angiograma normalaAngiograma normala
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– dextrograma şi levograma
Anatomie radiologicaAnatomie radiologica
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Anatomie vasculara – metode clasice
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Anatomie vasculara – angiografie
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Anatomie valve / coronare
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Anatomie radiologica / coronare
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Anatomie radiologica / coronare
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Anatomie cardiovasculara CT
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Anatomie cardiaca IRMAnatomie cardiaca IRM
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Sindromul vascularSindromul vascularpulmonarpulmonar
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Desenul pulmonarDesenul pulmonar
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Diferentierea intre arterele si Diferentierea intre arterele si venele pulmonarevenele pulmonare
• Artere– emerg arc costal post 7-8
– calibrul scade progresiv
– calibru <
– contur net
• Vene– intra arc costal post
8-9-10
– calibrul creste brusc
– calibru >
– contur flu
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Diferentierea intre arterele si Diferentierea intre arterele si venele pulmonarevenele pulmonare
• Artere– ramif. unghi ascutit– centrolobulare, insotesc bronhii– traiect vertical
– profil diverg plan post./vene
• Vene– converg in manunchi– extralobulare, nu se alatura bronhiilor– traiect orizontal, in lob sup. extern fata
de artere– profil converg plan ant. /artere
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Analiza vascularizatiei Analiza vascularizatiei pulmonarepulmonare
1
2
3
4
5
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Circulatia pulmonara Circulatia pulmonara functionalafunctionala
AD VD AP CP VP AS VS AO
Infarct pulmonar
Hipertensiune arteriala pulmonara
Hipertensiune venoasa
Edem pulmonar
Hemosideroza
Oligemie
Hiperemie
Hipertensiunea mixta
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Sindrome fiziopatologice ale Sindrome fiziopatologice ale modificarilor circulatiei pulmonaremodificarilor circulatiei pulmonare
• Modificari de debit
– diminuare (oligemie)
– crestere (hiperemie)
• Cresterea rezistentelor (hipertensiunea)
– precapilara (hipertensiunea arteriala - HTPA)
– postcapilara (hipertensiunea venoasa - HTPV)
– globala (hipertensiunea globala / mixta)
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Definitii hemodinamice ale Definitii hemodinamice ale hipertensiunii pulmonarehipertensiunii pulmonare
• VENOASA - – presiune capilara pulmonara > 10 - 12 mm Hg
• ARTERIALA - – PAP sistolica > 25 mm Hg
• SAU
– PAP medie > 15 mm Hg
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Cauze ale sindromelor vasculare Cauze ale sindromelor vasculare pulmonarepulmonare
• Oligemie – stenoza valvulara AP
– hipovolemie
– cardiopatii congenitale cu shunt D-S
• Hiperemie– insuficienta valvulara AP
– hipervolemie
– cardiopatii congenitale cu shunt S-D
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Cauze ale sindromelor vasculare Cauze ale sindromelor vasculare pulmonarepulmonare
• HTP venoasa– stenoza mitrala– orice obstacol intre AS si VS– insuficienta VS
• HTP arteriala– hipoxia prin hipoventilatie alveolara (cord pulmonar
cronic)– HTPA secundara (embolii, restrictie, HTPV)– HTPA primara
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OligemiaOligemia
• Hipertransparenta
• Hili mici, gracili (Danielus)
• Mantaua Felix larga
• Vase cu calibru mic
• Fara distensie toracica
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HiperemiaHiperemia
• Hili arteriali• vase pulmonare
dilatate• egalizarea
vascularizatiei pulm.• Mantaua Felix dispare• hipotransparenta
pulmonara
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Hipertensiunea pulmonara Hipertensiunea pulmonara venoasavenoasa
• Hil venos (Doppman & Lavender)
• Desen venos vizibil pana la periferie
• Mantaua Felix dispare
• egalizarea vascularizatiei pulmonare
Grad usor - 12 - 18 mmHg
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Hipertensiunea pulmonara venoasaHipertensiunea pulmonara venoasaGrad usor - 12 - 18 mmHg
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Hipertensiunea pulmonara Hipertensiunea pulmonara venoasavenoasa
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• Inversarea vascularizatiei pulmonare• liniile Sylla• edem interstitial
– hil mare, flu– pastile vasculare– benzi Kerley B
• transsudate pleurale– liber– inchistat
Hipertensiunea pulmonara Hipertensiunea pulmonara venoasavenoasa
Grad mediu - 18 - 25 mmHg
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Hipertensiunea pulmonara venoasaHipertensiunea pulmonara venoasaGrad mediu - 18 - 25 mmHg
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Hipertensiunea pulmonara venoasaHipertensiunea pulmonara venoasaGrad mediu - 18 - 25 mmHg
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Hipertensiunea pulmonara venoasaHipertensiunea pulmonara venoasaGrad mediu - 18 - 25 mmHg
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Hipertensiunea pulmonara venoasaHipertensiunea pulmonara venoasaGrad mediu - 18 - 25 mmHg
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Hipertensiunea pulmonara venoasaHipertensiunea pulmonara venoasaseverasevera
• > 25-30mmHg
• Hipotransparenta difuza pulmonara
• Desen vascular slab vizibil
• Edem interstitial
• + edem alveolar
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Hipertensiunea pulmonara venoasaHipertensiunea pulmonara venoasasevera - > 25 - 30 mmHg
• Edem pulmonar alveolar (acut)– sindrom de umplere
alveolara– central - aripi de fluture
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• Grad mediu - 25 - 50 mmHg
• Severa - > 50 mm Hg
• Creste rezistenta la nivel arteriolar
Hipertensiunea pulmonara Hipertensiunea pulmonara arterialaarteriala
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• Hil marit, arterial• desen periferic sarac (vasoconstrictie arteriolara)• trecere brusca (hil amputat - Goodwin)• Mantaua Felix largita• hil mare + plaman hipertransparent - Westermarck• arc II stg. modificat• indici
– diam. APD = 15 - 16 mm– indice arterio-bronsic = 1
Hipertensiunea pulmonara Hipertensiunea pulmonara arterialaarteriala
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Hipertensiunea pulmonara arterialaHipertensiunea pulmonara arteriala
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Hipertensiunea pulmonara arterialaHipertensiunea pulmonara arteriala
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Hipertensiunea pulmonara Hipertensiunea pulmonara arterialaarteriala
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