Atelectaziile

Arapan Ilie

Atelectazia:

Colaps saupierderea volumului pulmonar

Poate afecta un plamn ntreg, un lob, segment,
subsegment
5 mecanisme de formare:

Postobstructiv
Non-obstructiv de obicei datorat pierderii contactului
dintre foiele pleurale

Atelectazia NU cauzeaz febr

In a 1995 study of 100 postoperative cardiac surgery

patients receiving daily portable chest x-rays, no
association could be found between fever and amount of
atelectasis. This contradicts common textbook dogma but agrees
with previous human study and animal experiments.
Engoren, Milo. Lack of Association Between Atelectasis and Fever. Chest. Volume
107(1) January 1995 pp 81-84

A 1988 study of 270 patients after elective intraabdominal surgery found that neither the presence nor the
absence of fever can assure clinicians of the presence or absence
of a postoperative pathologic pulmonary complication such as
atelectasis. Roberts J, Barnes W, Pennock M, Browne GD. Diagnostic
Accuracy of Fever as a Measure of Postoperative Pulmonary
Complications. Heart Lung. 1988 Mar;17(2):166-70

Semne Xray

Directe:

Deplasarea fisurilor
Creterea densitii lobilori pulmonari
Bronhograme aerice non arhitectonice(postobstructive)
sau vase

Indirecte:

Deplasareastructurilor hilare
Deplasarea ipsilateral a mediastinului
ngustarea ipsilateral a spaiilor intercostale
Elevarea ipsilateral a hemidiafragmului
Hiperextensia plamnului sntos
Obscured structures adjacent to atelectasis

Semne tipice de
atelectazie:
1) creterea densitii
LSS(semn direct)
2) Deplasarea traheei
spre stnga(semn
indirect)
3) Semnul
Felson(semn indirect)

Colaps lobar

Anatomie

Poziia aproximativ a LSD, LM i LID la Xray toracic

Anatomie

Anatomie

Poziia aproximativ a LSS i LIS la Xray toracic

Anatomie

Atelectazie de LSD
Semne Rx:
Elevarea hilului stng sau a fisurii mici
Lobul colabat se deplaseaz cranial i medial
n neo central, fisure mic se deplaseaz cranial
cu o convexitate lateral superior i
convexitate medial inferior (semnul S a lui
Golden)

Atelectazie de LSD:
LSD atelectatic
formeaz opacitate
triunghiular(sgea
ta)
Fisura mic elevat
formeaz un S
inversat (S-sign of
Golden) mpreun
cu masa hilar (M).

Atelectazie de LM

Lobul mediu ocup 10% din volumul total

pulmonar
Tendin major de colaps
Radiographic findings can be subtle:

Opacitate triunghiular mic orientat lateral

Semnul siluetei pe dreapta la nivelul cordului
Inciden lateral: opacitate triunghiular cu vrful spre
hil

tergerea conturului drept al cordului

Fisura mic cobort

Profil:
Sgeile indic
fisurile mare i mic
paralele.
LM este opacifiat
ntre fisuri.

Atelectazii de LID

LID atelectatic se retrage posteromedial i inferior

Fisura mare se deplaseaz n jos i devine vizibil
Pe profil, 1/3 posterioar a hemidiafragmului drept este
acoperit de LID colabat. Pe Rx de fa hemidiafragmul
poate arta normal din cauza expansiunii LM

Atelectazie de LID
Opacitate
triunghiular n
hemitoracele
inferior drept.
Marginea lateral
este format de
fisura mere (normal
invizibil pe Rx de
fa).
Hilul drept deplasat
caudal.

Atelectazie de LSS

Opacitate tulbure n hemitoracele stng superior

50% dintre pacieni au fisura mare complet
Contururile trunchiului pulmonar i arterei pulmonare
stngi sunt terse
Hilul stng i LIS sunt retractate caudal
50% dintre pacieni au fisuramare incomplet

Tongue of aerated lower lobe is pulled forward by atelectatic

lobe, between the atelectasis and the aortic arch, forming a
crescent-shaped lucency (Luftsichel sign)

Elevare de hemidiafragm

Atelectazie LSS la un
pacient cu fisur
mare incomplet:
opacitate bine
definit.
Deviaia traheei spre
stnga i
tracionarea hilului
cranial
Sgeata indic
transparena
vertical delimitat
ntre arcul aortei i
marginea LSS
colabat (Luftsichel).

Atelectazie de LIS

Fracvent ntlnit dup chirurgie cardiac

Semne Rx:

Mrirea opacitii cardiace

Deplasarea caudal a hilului stng
tergerea conturului medial a hemidiafragmului stng
Deplasarea mediastinului poate cauza obliterarea
parial a arcului aortic

Atelectazie complet a unui plmn

Hemitorax opacifiat complet

Deplasarea ipsilateral a mediastinului
Ipsilateral cardiomediastinal shift (n efuzie
pleural masiv contralateral)
Semnul Felson la cord, hil i mediastin

Deviarea traheei
la stnga
Opacifierea
complet a
hemitoracelui
Semnul Felson

Deplasarea
cordului la
stnga

Mecanismele atelectaziei

Obstructive
Nonobstructive

Atelectazii obstructive

Cel mai frecvent tip

Rezult prin blocarea cilor aeriene

mucous plugging, foreign body, neoplasm, or

inflammatory debris

Distal de blocare loc rezorbia aerului din

alveolele neventilate
Nu se vizualizeaz bronhograma aeric

Cauze

Carcinom bronhogen la pacienii cu istoric de

atelectazii recurente, sau pneumonii recurente
cu rezolvare incomplet dup tratament.

Carcinoid bronhial(above considerations also

apply here)

Metastaze n bronii: mai frecvent carcinom

renal, carcinom de sn, melanom,
adenocarcinom de colon.

Cauze

Lymfom (stadii tardive i acompaniat de

limfadenopatie hilar i mediastinal) sau alte
cauze de limfadenopatii

Tuberculoza/ alte afeciuni granulomatoase

Dilatarea AS din stenoz mitral (atelectazie de

LIS)

Obstrucia cu corpi stini

Atelectazii nonobstructive
1)
2)
3)
4)

Pasive
Compresive
Prin cicatrizare
Adezive

n aceste forme de atelectazii broniile sunt

drenate. De aceea bronhoscopia nu poate fi
folosit ca metod de tratament.

Pasiv

Contactul ntre pleura parietal i

visceral se pierde.
1). Efuzie pleural
2). Pneumotorax
3). Hidrotorax, hemotorax
4). Hernie diafragmal
5). Mase pleurale(inclunznd metastazele i
mezotelioma)

Passive atelectasis:
Notice the crowded
air bronchograms
(arrows) in the
setting of a left
pleural effusion. Air
bronchograms are
not present in postobstructive
atelectasis.

Compresiv

Cauzat de compresiunea plamnului din

exterior
Poate fi cauzat de colecie pleural localizat,
mas tumoral n peretele toracic, pleur sau
parenchim

Compressive
atelectasis: Chest
x-ray showing a
giant bulla
occupying more
than two thirds
of the right
hemithorax and
compressing the
underlying lung
upward and
toward the
mediastinum.
Crowded air
bronchograms
can be seen
(arrows).

Adeziv

Cauzat de aderena pereilor alveolari n lipsa

surfactantului
Surfactantul reduce tensiunea superficial n
alveole

Adhesive atelectasis
in infant with
hyaline membrane
disease: CXR
reveals bilateral
ground-glass
appearance of the
lungs (atelectasis)
and air
bronchograms
standing (red
arrow) out against
the collapsed
parenchyma.

Cicatrizare

Secundar fibrozei parenchimului pulmonar cu

imposibilitatea expansiei plmnilor
Etiologia include:

boli granulomatoase
Sechele postTB
Pneumonia necrozant
Iradierea
Pneumoconioze

Cicatrization atelectasis:
Lung destruction in patient
with chronic pulmonary
tuberculosis.

Bibliografie:
Sharma, Sat. Atelectasis. e-medicine, 2004.
http://www.emedicine.com/med/topic180.htm#section~pictures
2) Brad H. Thompson, M.D., William J. Lee, B.S., Jeffrey R. Galvin, M.D. and
Jeffrey S. Wilson, M.D Lobar Anatomy ElectricLungAnatomy
www.vh.org/adult/provider/radiology/LungAnatomy/LobarAnat/LobarAnat.
html
3) Daffner, RH. Clinical Radiology The Essentials. Williams and Wilkins,
1993, pp 80-85.
4) Engoren, Milo. Lack of Association Between Atelectasis and Fever.
Chest. Volume 107(1) January 1995pp 81-84
5) Roberts J, Barnes W, Pennock M, Browne GD. Diagnostic Accuracy of
Fever as a Measure of Postoperative Pulmonary Complications. Heart
Lung. 1988 Mar;17(2):166-70
6) Stark, Paul. Atelectasis: Types and Pathogenesis. UpToDate, 2004.
7) Stark, Paul. Radiologic Patterns of Lobar Atelectasis. UpToDate, 2004.
8) Weed HG, Baddour LM. Postoperative Fever. UpToDate, 2004.
9) Federico Venuta and Tiziano de Giacomo. Giant Bullous Emphysema.
CTSNET Experts' Techniques, General Thoracic Experts' Techniques.
http://www.ctsnet.org/doc/6761
1)