sindromul alveolar modif 2
TRANSCRIPT
![Page 1: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/1.jpg)
![Page 2: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/2.jpg)
CURS TORACE
APARATUL RESPIRATOR
PROF.DR. IOAN CODOREAN
![Page 3: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/3.jpg)
SINDROAMELE TORACICE
• SINDROMUL PARIETAL• SINDROMUL PLEURAL• SINDROAMELE PULMONARE
A-SINDROMUL ALVEOLAR B-SINDROMUL INTERSTITIAL C-SINDROMUL BRONSIC D-SINDROMUL VASCULAR E-SINDROMUL PARENCHIMATOS
• SINDROMUL MEDIASTINAL• SINDROMUL CARDIAC
![Page 4: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/4.jpg)
SINDROMUL ALVEOLARSINDROMUL ALVEOLAR
1.1. Opacitati de densitate hidrica cu contur fluOpacitati de densitate hidrica cu contur flu
2.2. ConfluentaConfluenta
3.3. SistematizareaSistematizarea
4.4. Bronhograma si alveolograma aericaBronhograma si alveolograma aerica
5.5. Aspectul Aspectul inin aripi de fluture aripi de fluture
6.6. Nodulii alveolariNodulii alveolari
7.7. Evolutivitatea relativ rapidaEvolutivitatea relativ rapida
Cuprinde ansamblul de semne ce traduc prezenta de lichid Cuprinde ansamblul de semne ce traduc prezenta de lichid sau celule benigne sau maligne sau celule benigne sau maligne in interiorul alveolelorin interiorul alveolelor. . Exista Exista 7 semne radiologice specifice7 semne radiologice specifice: : Opacitatea, leziunea caracteristica se caracterizeaza prin mai multe semne radiologice
![Page 5: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/5.jpg)
Opacitati de densitate hidrica cu contur flu
Aspect flu datorat suprapunerii de lobuli normal aerati cu lobuli plini de lichid
exceptie: este net delimitata la nivelul unei scizuri
![Page 6: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/6.jpg)
SINDROMUL ALVEOLARSINDROMUL ALVEOLAR
1) 1) Opacitati Opacitati cu cu densitate hidrica cu densitate hidrica cu contur flucontur flu (sters) (sters)
Aspectul flu al aceAspectul flu al acessttoror tip tipuriuri de opaciati de opaciati se se datordatoreaza afectarii gradateeaza afectarii gradate al al grupurilor alveolare, unele fiind pline cu grupurilor alveolare, unele fiind pline cu lichid lichid iar altele au iar altele au inca continut aeric inca continut aeric normalnormal
EExceptie xceptie :atunci cand :atunci cand sunt delimitate de sunt delimitate de o scizurao scizura;; acea margine acea margine a opacitati a opacitati apare net delimitataapare net delimitata..
Edem alveolar Voal Opacitate
![Page 7: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/7.jpg)
Sistematizare lobara sau segmentara
• Majoritatea lobulilor dintr-un segment sau lob sunt afectati
• Cel mai frecvent opacitatile sunt triunghiulare cu varful in hil si baza la periferie
• De electie este incidenta de profil pentru a observa caracterul sistematizat
![Page 8: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/8.jpg)
Sistematizare lobara sau segmentara
LSD - segm apical (S1)
![Page 9: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/9.jpg)
Sistematizare lobara sau segmentara
LSD – segm posterior (S2)
![Page 10: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/10.jpg)
Sistematizare lobara sau segmentara
LSD – segm anterior (S3)
![Page 11: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/11.jpg)
Sistematizare lobara sau segmentara
opacitate in LSD
![Page 12: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/12.jpg)
Sistematizare lobara sau segmentara
LM segm lateral (S4)
![Page 13: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/13.jpg)
Sistematizare lobara sau segmentara
LM segm medial (S5)
![Page 14: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/14.jpg)
Sistematizare lobara sau segmentara
Pneumonie lob mediu
![Page 15: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/15.jpg)
Sistematizare lobara sau segmentara
segm mediobazal(S7)
LID
segm superior(S6)
![Page 16: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/16.jpg)
Sistematizare lobara sau segmentaraLID
Segm antero-bazal (S8)
segm postero-bazal (S10)
Segm latero-bazal (S9)
![Page 17: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/17.jpg)
Sistematizare lobara sau segmentara
Pneumonie segment antero-bazal LID
![Page 18: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/18.jpg)
Sistematizare lobara sau segmentara LSS
- segm apicoposterior (S1+2)
- Segm anterior (S3)
![Page 19: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/19.jpg)
Sistematizare lobara sau segmentaraLSS
- segm lingular superior (S4)
- Segm lingular inferior (S5)
![Page 20: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/20.jpg)
Pneumonie LSS segm ant
Sistematizare lobara sau segmentara
![Page 21: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/21.jpg)
Sistematizare lobara sau segmentaraLIS
segm sup segm antero bazal segm latero-bazal segm postero-bazal
![Page 22: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/22.jpg)
Sistematizare lobara sau segmentara
Pneumonie LISSegm sup
![Page 23: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/23.jpg)
Tendinta la confluare
Umplerea alveolara se face treptat prin porii Khon si canalele Lambert
Favorizeaza confluenta progresiva a leziunilor si respectiv a opacitatilor
Confluenta un semn evocator dar nu patognomonic
![Page 24: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/24.jpg)
Bronhograma si alveolograma aerica
Semn de atingere parenchimatoasa de origine alveolara
Bronhograma aerica= o transparenta tubulara ce se bifurca, formata din bronhii normale in cadrul unei opacitati
Alveolograma aerica = alveole pline cu aer inconjurate de alveole pline cu lichid
![Page 25: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/25.jpg)
Noduli alveolari
leziunea elementara forma rotund sau ovalara contur sters de dimensiunea unui acin
(0.5 cm diametru) uneori vizibila la periferia
unor opacitati confluente la debut
se numesc si noduli acinari
![Page 26: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/26.jpg)
Aspect de aripi de fluture
• Localizare de o parte si de alta a celor doua hiluri
• Opacitatea atinge bazele dar respecta periferia si varfurile
![Page 27: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/27.jpg)
Evolutie relativ rapida si precoce
• Opacitatile isi modifica dimensiunile (crestea/diminuarea) in cateva zile
• Exista si opacitati cronice care evolueaza mai lent
![Page 28: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/28.jpg)
Etiologia
Infectii: - pneumonii - bronhopneumoniiEdem pulmonar : - cardiogen - necardiogenTumori : - carcinom alveolar - limfom - leucemieNeonatal : - boala membranelor hialine - aspiratiealtele : - hemoragii pulmonare - sdr. Good Pasture - infarctul pulmonar - proteinoza alveolara - pneumonita de iradiere - sarcoidoza - leptospiroza - plaman eozinofilic - etc.
![Page 29: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/29.jpg)
Pneumonii bacteriene
Evolutie : anatomopatologic mai multe etape
I. Congestie : opacitate de intensitate micaII. Hepatizatie rosie : opacitate intensa, sistematizata,
omogena, prezenta bronhogramei aerice
III. Hepatizatie cenusie : “opacitate in rezolutie”IV. Cronicizarea : opacitate retractila cu/fara bronsectaziiV. Hepatizatie galbena : abces
![Page 30: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/30.jpg)
Pneumonia cu pneumococ
• Pneumonia tipica • Bronhograma aerica prezenta• Nu caviteaza • Nu da reactie pleurala
![Page 31: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/31.jpg)
Pneumonia cu Streptococ
• De obicei urmeaza leziunilor virale• Nu da pleurezie• Localizarea de electie lobii inferiori
![Page 32: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/32.jpg)
Pneumonia cu Stafilococ
Opacitati micro sau macronodularediseminate bilateral neomogeneImagini buloase (hipertransparente centrale delimitate de un inel opac)
Imagini hidro-aerice
![Page 33: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/33.jpg)
Pneumonia cu Klebsiella
• Predilectie pentru lobii superiori• Marire de volum a lobului afectat• Caviteaza si produce empiem• Are bronhograma aerica
![Page 34: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/34.jpg)
Pneumocistis carinii
la pacientii imunodeprimati lez progresive: - debut – leziuni perihilare - continua – pata alveolara - faza terminala – opacitati masive bilaterale Eozinofilie variabila asociata
![Page 35: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/35.jpg)
Aspergiloza
- la pacientii imunodeprimati
- poate coloniza arborele bronsic lezat, chisturile sau cavitatile pulmonare la pacientii cu afectare pulmonara subiacenta (TBC, histoplasmoza)
Rx : micetomul pulmonar nodul solitar intr-o cavitate eventual neexistenta delimitat de o transparenta semilunara
![Page 36: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/36.jpg)
Bronhopneumonii
• Leziunea elementara : focar de bronhoalveolita• Imaginea radiologica : - opacitati multiple - neregulate - rotunde sau ovalare - dimensiuni diferite - contururi sterse - intensitate mai mare in centru si
descreste in periferie - mare variabilitate a imaginii (de la o zi la alta) la copilul mic – opacitati miliare/micronodulare - predominantin reg. perihilara la adult – opacitati macronodulare - tendinta la confluare = opacitati intinse la unul/
mai multe segm/un lob (forma pseudolobara) - mai frecvent in regiunile bazale
![Page 37: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/37.jpg)
Bronhopneumonii
![Page 38: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/38.jpg)
Edem pulmonar acut
1. Cardiogen2. Necardiogen - insuficinta renala (uremia) - incarcarea volemica - plamanul de soc - neurogenic - hipoalbuminemie - accidente transfuzionale - traumatic - droguri - inhalarea de gaze toxice - inecati - altitudine - etc.
![Page 39: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/39.jpg)
Edem pulmonar acut
Rx : opacitati difuze, nodulare slab delimitate mai
mult sau mai putin confluente in treimea medie a campurilor pulmonare si mai
ales perihilar aspect de aripi de fluture bronhograma aerica prezenta
![Page 40: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/40.jpg)
Edem pulmonar acut
![Page 41: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/41.jpg)
Carcinom alveolar
• Histologic – ca metastaza a unui neoplasm la distanta
• Forma localizata – nodul mic periferic cu bronhograma aerica
• Forma difuza – de la noduli multipli imprecis delimitati la infiltrate masive cu forme neregulate si bronhograma aerica
![Page 42: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/42.jpg)
Infarcul pulmonar
• Localizare lobara inferioara si sinus costodiafragmatic
• Pleurezie asociata
• Hemidiafragm ascensionat
• Remisiunea nu modifica forma dar reduce volumul
![Page 43: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/43.jpg)
Proteinoza alveolara
• Infiltrate difuze
• Consolidare perihilara sau bazala
• Bronhograma aerica nu este comuna
![Page 44: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/44.jpg)
![Page 45: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/45.jpg)
Limfom Hodgkin
• Cea mai comuna prezentare adenopatie mediastinala
• Ganglionii perivasculari si paratraheal cel mai frecvent afectati
• Pulmonar - opacitati izolate de
forme nedefinite - pot conflua in mase
neomogene
nesistematizate
![Page 46: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/46.jpg)
Sdr. Good Pasture
• etiologie - autoimuna• adult tanar predominant la
barbati• se asociaza cu boala renala - glomerulonefrita• Radiologic - infiltrate perihilare si
bazale - respecta varfurile si unghiurile costofrenice - dispare in cateva zile - urmata de fibroza pulmonara
![Page 47: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/47.jpg)
Plaman eozinofilic
Etiologie Cunoscuta - micoze - infectii parazitare - reactii medicamentoase Idiopatica - sdr. Loffler - pneumonia eozinifilica ac si cr - sdr. hipereozinofilic- prezenta eozinofilelor in sangele periferic- infiltrat Loffler : opacitati nesegmentare, tranzitorii, rapid
variabile localizare : predominent periferic
perpendicular pe pleura
![Page 48: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/48.jpg)
Pneumonita de iradiere
• Opacitati neregulate
• Localizate pe campurile de iradiere
![Page 49: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/49.jpg)
Pneumonia de aspiratie
• Opacitati bilaterale in zonele medii si inferioare ale plamanilor
![Page 50: SINDROMUL ALVEOLAR modif 2](https://reader030.vdocuments.pub/reader030/viewer/2022012307/55cf9dd6550346d033af7731/html5/thumbnails/50.jpg)
Pneumonia cu Legionella
Factori de risc : boli debilitante (DZ, IRC) HIV alcool fumatRx: nespecific bronhopneumonie unilaterala uneori bilaterala revarsat pleural putin cantitativ