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RADOMAGSTCA

TORACELU
CATEDRA DE RADIOLOGIE SI IMAGISTICA MEDICALA SUUB
UMF CAROL DAVILA
TEHNC DE NVESTGARE.NDCAT
RADIOGRAFIA PULMONARA
de fata:
incidenta P-A A-P d.d., poz. sezanda
nsp7 exp7 dgn. pneumoto7ax, tulbu7a7 de ventlate
manev7e Valsalva Muelle7 modf.a7le vas.ula7zate pulmona7e, studul maselo7 vas.ula7e
hpe7lo7doza studul va7fu7lo7 pulmona7e
.u 7aze du7e-mo
de.ubt late7al 7eva7sate pleu7ale
.op:fa7a g7la, n statv de .ontente
p7ofl
obl.e
tntte, tangentale
! .ompa7a7ea .u 7g7. ante7oa7e
! 7g7 dgtala: 7ezolute spatala ma m.a
RADIOSCOPIA TELEVIZATA
examen dnam. al daf7agmelo7, lezunlo7 pleu7o-pulmona7e- tmpul nsp7ato7, manev7e Valsalva,
tuse, pozte s n.denta
MRF
depsta7e n masa, doza de 7ade7e ~ 7g7. to7a..e, .ost 7edus
TOMOGRAFIA CONVENTIONALA
utla .and nu se dspune de CT
.onf7ma:
o lezune vzbla pe 7g7.
sedul nt7apulmona7 al lezun
lezun stuate n va7fu7le hlu7le pulmona7e
TRANZITUL BARITAT n lezun ale medastnulu poste7o7, pneumopat de nhalate
BRONHOGRAFIA lo.ul e luat de b7onhos.ope s CT (b7onse.taz, malfo7mat b7onho-pulmona7e)
LIMFANGIOGRAFIA
RGR.PULMONARA DE FATA RGR. PULMONARA DE PROFIL
TOMOGRAFIE CONVENTIONALA
BRONHOGRAFIE FLEISCHNER
TOMOGRAFA COMPUTERZATA
:tiIa in stadiaIizarea t:24riI4r
detectarea 2etastazeI4r p:I24nare si pIe:raIe
diagn4stic:I Iezi:niI4r parietaIe/ pIe:raIe/ p:I24nare/ hiIare
high res4I:ti4n - :tiIa in b4IiIe p:I24nare dif:ze/ br4nsiectazii
angi4CT: p4ate viz:aIiza e2b4Iii in vase de pana Ia 2-3 22
ghidare p:nctii-bi4psii sa: drenaje
SCNTGRAFA
st:dii de perf:zie - c: Tc - in s:spici:niIe de e2b4Iie p:I24nara
st:dii de ventiIatie - c: Xe, Kr - evaI:area e2fize2:I:i
ANGOGRAFA
g4Id standard-:I" ptr. e2b4IiiIe p:I24nare
2aIf4r2atii vasc:Iare, pediatrie - expI4rare p:I24nara f:ncti4naIa
ECOGRAFA
p4ate expI4ra pereteIe t4racic/ diafgrag2:I / pIe:ra + ghidare a p:nctiei
OPSA
ptr. diagn4stic:I in t:24riIe p:I24nare / pIe:raIe / parietaIe 2aIigne
RM
diagn4stic:I 2aseI4r hiIare / Ii2faden4patiiI4r / Iezi:niI4r 2ediastinaIe
TEHNC DE NVESTGARE.NDCAT
ANATOMA RADOLOGCA
Pasii de :r2at in interpretarea radi4grafiiI4r + CT:
C7te7 de exec:tie c4recta a .lseelo7
Analza c4ntinat4r:I:i
s.helet : .oloana, ste7n, .oaste, .lav.ule, .ap hume7al
pa7t mo: pe7ete to7a..,glanda mama7a, axle, gat, daf7agm
Analza c4ntin:t:I:i
pleu7a
plaman
medastn
CONTINATOR
Rgr. fata Rgr. pr4fiI
C4I4ana
vertebraIa
+ CT
- p7mele 3-4 v. to7a.ale
- .o7p, ap. spnoasa, ped.ul
~ap. t7ansve7se
-spatle
nte7ve7teb7ale
-g. de .onjuga7e
Stern
+ CT
ma7gne supe7oa7a d7eapta
manub7u, ev. obl.e
-toate .ele t7e
segmente
C4aste
+ CT
-n7., st7u.tu7a, .ontu7u7
-o7enta7ea (pozte s n.denta)
-spatle nte7.ostale
-df.l
-a7.u7 poste7oa7e
de.alate stg -d7
CartiIaje
c4staIe
Cal.f.a7 - .ent7ale
- pe7fe7.e
CIavic:Ie -sup7apuse pe va7fu7le pulmona7e
-.ontu7u7 nete
O24pIati -spna, va7ful, ma7gnea nte7na - 2 ln opa.e
obl.e
Parti 24i
parietaIe
+ CT
-mm. SCM
-p. mo sup7a.lav.ula7e
-mm. pe.to7al
-gl. mama7a + mameloane
Diafrag2
+ CT
-.upole .onvexe .7anal
-d7. ma sus .a stg., poz: .V ant.
-nse7t .ostale
-pa7alele d7
-nte7se.tate - stg
CONTINATOR
CONTINUT
Rgr. fata Rgr. pr4fiI
PIe:ra -vzbla doa7 n n.denta tangentala
-domul pleu7al
-s.zu7a o7zontala d7. n d7. .oaste V
-s.zu7 sup7anume7a7e: azygos, ap.ala L, pa7a.a7da.a, lngula7a
-s.zu7a o7zontala +
obl.e
-s.zu7le sup7anume7a7e:
lngula7a, ap.ale ale L
f4r2area sciz:rii b:Ib:I:i
venei azig4s
CONTINUT
Arb4re
trahe4-
br4nsic
-t7ahee medan
-bfu7.ate T4-T5
-ungh bfu7.ate 40-70%
-b7onha stg ma o7zontala
-t7ahee n
med.mjl.
-.a7na + b7.
stg : o7tog7ade
PIa2an Hipertransparente (ae7) +
+nte7sttu,pe7et b7ons., a7te7e,
vene, lmfat.e F 7adolog.:
4pacitati arteriaIe (hl F manta)
= Spat .la7e
-7et7oste7nal
-7et7o.a7da.
LOB SUPERIOR LOB MIJLOCIU LOB INFERIOR
SEGMENTATIA PULMONARA
Ap
D
V
Ax
apicaI
bazaI
CONTINUT
CT
PIe:ra S.zu7le :
-spat avas.ula7e
-benz dense
-plaje ds.7ete de atenua7e .7es.uta
Arb4re trahe4-
br4nsic
=benz sau magn 7otunde de denstate
ae7.a, n.onju7ate de pe7ete dens
PIa2an =atenua7e s.azuta
+ a7te7e, vene : benz sau nodul
- hlu7le pulmona7e: bne vzble
IRM
CT
FALSE IMAGINI PATOLOGICE. VARIANTE DE NORMAL
cartiIaje c4staIe caIcificate
s:prap:nere de par, bij:terii,
i2braca2inte
nedegajarea 2arginii interne
a brat:I:i sa: scap:Iei
2a2eI4ane
2arginea externa a san:I:i
n:cIei epifizari iz4Iati
anc4se c4staIe
f4seta Iiga2ent:I:i r42b4id
c4aste s:pran:2erare,
hip4pIazii, sinst4ze, bifiditati
SEMOLOGE
GENERALA
.Asi2etrie de f4r2a, di2ensi:ni si transparenta
a .elo7 doua hemto7a.e
2.OPACITATI
a. N:2ar
b. L4caIizare
c. F4r2a
d. Di2ensi:ni
a. p:nctif4r2e
b. 2icr4n4d:Iare ( pana Ia 322
c. n4d:Iare ( : 322 - c2
d. 2acr4n4d:Iare ( peste c2
e. intinse
f. 2asive
e. Intensitate
f. Str:ct:ra
a. 424gena
b. ne424gena : caIcificari, transparente
g. C4nt:r:ri
a. netitate
b. f4r2a
h. ReIatii c: vecinii
3.HIPERTRANSPARENTE
a. dif:ze desen p:I24nar vizibiI
b. Circ:2scrise
a. c: ineI 4pac fin
b. c: ineI 4pac gr4s
4.IMAGINI MIXTE = hidr4-aerice
SEMOLOGE
GENERALA
SEMNUL SILUETEI (FELSON
2 opa.tat stuate n a.elas
plan s ste7g .ontu7ul la
nte7fata
BRONHOGRAMA AERIANA
7amu7le b7ons.e ae7ate apa7
7adot7anspa7ente dato7ta
dspa7te ae7ulu dn alveole
pneumon
boala memb7anelo7 halne,
lmfom, sa7.odoza, .a7.nom
alveola7, sd7. de det7esa
7esp7ato7e a adultulu
UNGHIURILE BERNOU
Stables. apa7tenenta la
pe7ete sau la plaman a une
opa.tat
SINDROAME RADIOLOGICE
. SINDROMUL PARIETAL = ansa2bI:I de se2ne
radi4I4gice ce trad:c 4 atingere a pereteI:i t4racic (parti 24i,
scheIet
2. SINDROMUL PLEURAL
3. SINDROAMELE PULMONARE
a. SINDROMUL ALVEOLAR
b. SINDROMUL INTERSTITIAL
c. SINDROMUL BRONSIC
d. SINDROMUL VASCULAR
e. SINDROMUL PARENCHIMATOS
. SINDROMUL PARIETAL
LEZIUNILE PARTILOR MOI
Cresteri I4caIizate aIe gr4si2ii
pereteI:i
= opa.tat omogene, ntenstate
va7able, 7a.o7date n panta lna,
eventual .u lze7eu t7anspa7ent de
dema7.ate fata de plaman
(dezvoltate endo.avta7)
Cresteri/ red:ceri dif:ze aIe
gr4si2ii (.ompa7atv)
hpe7t7ofe m. pe.to7al
asmet7 .ongentale
ageneze de m. pe.to7al
maste.tome
at7ofe mus.ula7a de .auza
neu7olog.a
CaIcificari :
adenopat
pa7aztoze
hematoame ve.h
Hipertransparente:
emfzem sub.utanat
. SINDROMUL PARIETAL
LEZIUNILE SCHELETULUI
OSOS
M4dificari c4staIe
N:2ar:
c4aste s:pran:2erare,
hip4/apIazii, absenta
c4ngenitaIa/ d4bandita
Di2ensi:ni:
24dificari generaIizate/
I4caIizate
P4zitie, 4rientare
tip:I c4nstit:ti4naI
hiperinfIatie,pIe:rezie,
ateIectazie, fibr4t4rax
24dificari de ax aIe CV
C4nt:r
c4arctatie A4,
ne:r4fibr42at4za, fract:ri
Str:ct:ra
4ste4Iitice,
4ste4c4ndensante, 2ixte
. SINDROMUL PARIETAL
LEZIUNILE SCHELETULUI
OSOS
M4dificariIe c4I4anei
vertebraIe
de ax:
sc4Ii4ze, cif4ze,
sdr. spateI:i drept
24dificari de f4r2a
- er4zi:ni fata anteri4ara
c4rp:ri vertebraIe:
anevris2 A4
- Iargirea g. de c4nj:gare :
ne:rin42
24dificari de str:ct:ra
24dificari aIe spatiiI4r i.v.:
pensari, caIcificari, vid
discaI
M4dificariIe stern:I:i,
etc.
. SINDROMUL PARIETAL
LEZIUNILE DIAFRAGMULUI
p4zitie
S:s sit:at
biIateraI :niIateraI
- expir
- sarcina
- ascita
- t:24ri abd. v4I:2in.
-4bezitate
-hepat4spIen42egaIie
- red:cerea
c42pIiantei p:I24nare
- hepat42egaIie
- spIen42egaIie
- pareza de nv frenic
- ateIectazie
- fibr4za p:I24nara
- pne:24nect42ie
- pahipIe:rita
- sc4Ii4ze
J4s sit:at : hiperinfIatie, inspir pr4f:nd
c4nt:r:
alte7a7e tonus fb7e
mpnge7e t7a.tona7e
24biIitate: 7edusa, absenta, pa7adoxala
r:pt:ri, hernii diafrag2atice
2. SINDROMUL PLEURAL
PLEUREZII
. Iibere in 2area cavitate
pIe:raIa
2ici, 2edii, 2asive
2. inchistate
parietaI
diafrag2atic
2ediastinaI
interI4bar (sciz:raI
PNEUMOTORAX
HIDROPNEUMOTORAX
PLEUREZII
PNEUMOTORAX
HIDROPNEUMOTORAX
PAHIPLEURITE
TUMORI PLEURALE
PNEUMOTORAX
Iiber in 2area cavitate
2edi::
hpe7t7anspa7enta pe7fe7.a
fa7a desen pulmona7
.olaba7ea plamanulu la hl: bont pulmona7
ma opa. .ent7at pe hl, bo7dat de un fn
lze7eu opa. = pleu7a vs.e7ala
medastn nemodf.at .a pozte
hpe7nflate a plamanulu .ont7olate7al
uneo7: benz opa.e n pe7met7ul
t7anspa7ente = ade7ente pleu7ale
2ic
df.l de evdentat
banda fna hpe7t7anspa7enta, fa7a desen
pulmona7, ap.o-late7ala
7g7. n exp7 fo7tat, 7ados.opa
CT
i2p4rtant, s:f4cant (c: s:papa
u7genta .ln.o-7adolog.a
pp o solute de .ontnutate de ma7
dmensun, .u supapa
mpo7tant efe.t de masa
partiaI, cI4az4nat ! diagn4stic:I diferentiaI
PLEUREZII
PNEUMOTORAX
HIDROPNEUMOTORAX
PAHIPLEURITE
TUMORI PLEURALE
2. SINDROMUL PLEURAL
FORMATIUNI
SOLIDE
WPAHIPLEURITE
WTUMORI PLEURALE
BENIGNE
WFb7om, angom,
.ond7om, tumo7a
amloda, Iip42
WMez4teIi42 I4caI
benign
WTUMORI PLEURALE
MALIGNE
W pri2are
Wfibr4sarc42
W2ez4teIi42
dif:z
Wsec:ndare
PLEUREZII
PNEUMOTORAX
HIDROPNEUMOTORAX
PAHIPLEURITE
TUMORI PLEURALE
2. SINDROMUL PLEURAL
3. SINDROAMELE PULMONARE
A. SINDROMUL ALVEOLAR
= disparitia aer:I:i din aIve4Ie si
inI4c:irea I:i printr-:n fI:id
(ex:dat, trans:dat,sange
FOPACITATE ALVEOLARA
(EXUDATIVA"
-intensitate s:b2ediastinaIa, 2ai
sIaba spre periferie
-str:ct:ra 424gena
-prezenta br4nh4gra2ei si
aIve4I4gra2ei aeriene
-c4nt:r:ri sterse / nete Ia sciz:ri
-ev4I:tie rapida
-n: 24difica vecinii"
-siste2atizate / nesiste2atizate
Infectii - pne:24nii, br4nh4pne:24nii
Ede2 p:I24nar cardi4gen / necardi4gen
Ne4nataI: b4aIa 2e2braneI4r hiaIine, aspiratie
He24ragia p:I24nara, sdr. G44d - Past:re, infarct
p:I24nar
T:24ri :
carcin42 aIve4Iar
Ii2f42
Ie:ce2ie
AIteIe:
pr4tein4za aIve4Iara
pne:24nita de iradiere
Sarc4id4za
pIa2an e4zin4fiIic
INDICATII
CT
ca:tarea Iezi:niI4r excavate
ca:tarea eti4I4giei / Iezi:ni asc:nse de sdr.
aIve4Iar
ghidarea p:nctiei
IRM: interes te4retic in
pne:24patiiIe de inhaIare (c: :Iei:ri
pr4tein4ze
he24ragii intra-aIve4Iare
3. SINDROAMELE PULMONARE
A. SINDROM ALVEOLAR - ca:ze
CONTUZII PULMONARE
PNEUMONITA DE IRADIERE
PNEUMONIILE BACTERIENE
FAZA ANAPAT RADOLOGE
CLASCA
DURATA
CONGESTE
diIatarea
capiIareI4r
ex:dat ce
4c:pa partiaI
aIve4IeIe
ingr4sarea
peretiI4r
aIve4Iari
4pacitate de intensitate f4arte
2ica = v4aI
24 4re
Zi:a
HEPATZATE
ROSE
aIve4IeIe
4c:pate in
t4taIite de
he2atii=bI4c
Opacitate intinsa
siste2atizata
intensitate s:b2ediastinaIa
c4nt:r:ri nete d4ar Ia sciz:ri
424gena
br4nh4gra2a si aIve4I4gra2a
aeriana
4-5 ziIe
Z 2-6
PNEUMONIILE BACTERIENE
HEPATZATE
CENUSE
c4ntin:t:I
aIve4Iar se
eIi2ina partiaI,
intrand si aer in
aIve4Ie
Opacitate in rez4I:tie"
de Ia periferie spre centr:
din centr: spre periferie
in tabIa de sah
2-5 ziIe
Z7-4
aspect n4r2aI
d:pa 3 sapt.
CRONCZARE
pred42ina
fibr4bIastii
Opacitate retractiIa
Ibr4nsiectazii
HEPATZATE
GALENA
AIve4Ie pIine
de pi4cite
Perete aIve4Iar
distr:s
Abces In peri4ada
febriIa sa:
d:pa
FAZA ANAPAT RADOLOGE
CLASCA
DURATA
Pneumone axla7a LSD
Pneumone axla7a LSD n 7ezolute
Pneumone LM n 7ezolute
Pneumone ap.ala LD
Pneumone bazala LD
Pneumone lngula7a
Pneumone LS
Faza de ab.eda7e
Faza de 7ezolute
Pneumone pseudotumo7ala
Pneumone nfa7.t pulmona7
BRONHOPNEUMONII
ANAPAT:
p7o.ese de b7onhoalveolta, edem, atele.taz
RX:
ma multe opa.tat nodula7e
unblate7al
.ent7u ma opa., pe7fe7a ma ntensa
.ontu7u7 dfuze
dmensun va7ate s 7apd va7able
tendnta la .onflua7e
Fo7me 7adolog.e: mla7a, m.7onodula7a, ma.7onodula7a,
pseudoloba7a
Fo7me etolog.e: STF, STR, GRAM-
BRONHOPNEUMONIA
Anatomopat:
Fo7me a.ute, galopante tablou .ln. de
edem pulmona7 g7av
Fo7me nsdoase ab.ese pe7b7ons.e .a7e
ulte7o7 .omun.a .u b7onha s apa7
pneumato.ele
Rx:
Nodul
magn buloase
magn hd7o-ae7.e
Aspe.t polmo7f
Remane7e n tmp s.u7t
Pa7t.ula7tat:
Cop:
60% pneumato.ele
90% 7eva7sat pleu7al sau pneumoto7ax
popneumoto7ax
Adult:
ma f7e.vent fo7ma pneumon.a
20-50% fo7ma buloasa
50% 7eva7sat pleu7al .u tendnta la n.hsta7
multple
foa7te 7a7 popneumoto7ax
STAFILOCOCICA
Rx:
Lob nfe7o7
Nu exsta tendnta pent7u
dezvolate7a pneumato.elelo7
sau a popneumoto7axulu
Empem obsnut + ade7ente
STREPTOCOCICA
BRONHOPNEUMONIA
LESELLA
segmente poste7oa7e ale loblo7
supe7o7 s segmentele supe7oa7e ale
loblo7 nfe7o7, ma f7e.vent pe d7eapta
opa.tate loba7a segmenta7a
tendnta la exudate nflamato7
volumnoase, pputand afe.ta nt7eg
plamanul
tendnta la ab.eda7e .u fo7ma7e de
.avtat
PROTEUS
segmente poste7oa7e lob supe7o7
segmente supe7oa7e lob nfe7o7
ab.eda7e f7e.venta
aspe.t b7onhopneumon.
E.COL
ne.a7a.te7st.
GRAM (-
POCANC
segment poste7o7 lob nfe7o7
opa.tat nodula7e multple .u
tendnta la .onglome7a7e
fo7ma7e de opa.tat
pneumon.e .u
b7onhog7ama ae7ana
Br4nh4pne:24nia c: B.Gra2 (-
7onhopneumone
noso.omala
B. SINDROMUL INTERSTITIAL
= ansamblul de semne 7adolog.e .e atesta ng7osa7ea t7ame de tesut
.onjun.tv al plamanulu
(compartiment peribronhovascular, interlobular, parietoalveolar)
CAUZE
nflt7ate l.hdana
(edem
hemodnam.,
nflamato7, tox.)
staza venoasa
.7on.a sau lmfat.a
p7olfe7a7e de .elule
ano7male
Caracteristici radi4I4gice:
Wnesiste2atizate
Wc4nt:r net
Wabsenta c4nfI:arii
Wev4I:tie Ienta
LEZIUNI ELEMENTARE
Opacitati n4d:Iare
Opacitati Iineare
Opacitati retic:Iare
B. SINDROMUL INTERSTITIAL
I2agini Iiniare : IiniiIe septaIe (KerIey
ede2 interstitiaI prin staza Ii2fatica
F ac:te: ede2 p:I24nar, pne:24patii
viraIe
F cr4nice: cancer br4nsic c: 4bstr:ctie
Ii2fatica, Ii2fangita carcin42at4asa,
pne:24c4ni4ze, sten4za 2itraIa,
sarc4id4za, Ii2f42, Ii2fangi42i42at4za,
pr4tein4za aIve4Iara
I2agini retic:Iare:
= Ingr4sare sept:ri interI4b:Iare si
interI4bare, centrate pe artera
centr4I4b:Iara
F aIve4Iita aIergica extrinseca
F 2aIadii siste2ice
F fibr4za interstitiaIa dif:za
F pne:24cist4za
F Ii2fangita carcin42at4asa.
I2aginea in fag:re de 2iere"
= spatii aeriene chistice
inc4nj:rate de retea 4paca
gr4siera, disp:sa paraIeI c:
pereteIe
=distr:ctie p:I24nara in faze
tardive de fibr4ze interstitiaIe:
FHisti4cit4za X
FFibr4za interstitiaIa pri2itiva
FPne:24c4ni4ze
FSarc4id4za
FAIve4Iita aIergica
B. SINDROMUL INTERSTITIAL
Fibr4za p:I24nara dif:za idi4patica
B. SINDROMUL INTERSTITIAL
I2aginea de gea2 2at", sticIa pisata"
= afectare interstitiaIa Ia deb:t =
2icr4n4d:Ii f4arte fini Fin ansa2bI:
i2agine 4paca fI:
-HRCT: vaseIe vizibiIe in aria de
crestere dif:za a densitatii
Finfecti4ase (viraIe, pne:24cist4za
in c:rs:I SIDA
Fi2:n4aIergice (aIve4Iita extrinseca
Fsarc4id4za : deb:t (+2icr4n4d:Ii
Sida, pne:24cistis carinii
Histi4cit4za
AIve4Iita extrinseca
B. SINDROMUL INTERSTITIAL
Opacitati p:nctif4r2e, 2icr4n4d:Iare
F 2iIiara t:berc:I4asa
F 2iIiara carcin42at4asa
F pne:24c4ni4ze
F sarc4id4za
F fibr4za interstitiaIa idi4patica
F af. infecti4ase (pne:24patii viraIe, 4p4rt:nisti,
2ic4ze, parazit4ze
F ne4pIazii (cancer br4nhi4I4-aIve4Iar, Ii2f42,
Ie:ce2ie
F b4Ii de c4Iagen
F 2icr4Iitiaza aIve4Iara
F he24sider4za
Opacitati 2acr4n4d:Iare
F T:berc:I4za
F Metastaze
F Pne:24c4ni4ze
F Abcese p:I24nare 2:ItipIe
F Hidatid4za ..
EIe2ente de diagn4stic:
F Distrib:tia (biIateraIa / :niIateraIa, nesiste2atizata, dif:za,
bazaIa
F As4cierea aIt4r an42aIii parenchi2at4ase si pIe:raIe
F Lezi:ni ggI
F CaIcificari
F An42aIii cardiace
F An42aIii 4s4ase
F Ana2neza, ev4I:tie, c4reIatii bi4I4gice, f:ncti4naIe si
anat424pat4I4gice
Sarc4id4za
Pne:24c4ni4ze SiIic4za
Azbest4za
ETOLOGA:
My.oplasma pneumonae
v7usu7 (nfluenza, pa7anfluenza, VSR, v7usul 7ujeole,
Coxsake, adenov7usu7, he7pes v7us, v7usul va7.ele,
CMV)
ANAPAT:
edem, nflt7at hsto.ta7, mono.ta7 s plasmo.ta7 al
nte7sttulu pe7b7onhovas.ula7 I alveole
Rx:
p7edomna n lob nfe7o7, segmente poste7oa7e
a..entua7ea desenulu pulmona7 pe7b7onhovas.ula7 s
pe7a.na7 pe7lobula7
magnea 7adolog.a se .onsttue de tmpu7u n 7apo7t .u
debutul .ln.
n 15 zle: 7eso7bte (ntal atele.tazle lobula7e, apo
.omponenta alveola7a s n fnal .ea nte7sttala)
n 25 zle: no7malza7e 7adolog.a
pn. .u my.oplasme: ma g7ava, ma p7elungta
PMEUMOMIA IMTEPSTITIALA
PNEUMONA NTERSTTALA
PNEUMONE VRALA
C. SINDROMUL
BRONSIC
IMAGINI DIRECTE
INGROSAREA PERETILOR
BRONSICI
c: caIibr: n4r2aI
F infIa2atie cr4nica
br4nsica
c: caIibr: cresc:t
F br4nsiectazii
IMAGINI INDIRECTE
c4nsecinte ventiIat4rii
4bstr:ctie
c42pIeta F
ateIectazii
p:I24nare,
I4bare,
seg2entare
4bstr:ctie
inc42pIeta F
ateIectazie
inc42pIeta
hiperinfIatie
(air-trapping
c4nsecinte circ:Iat4rii
evanescenta
p:I24nara
C. SINDROMUL
BRONSIC
C. SINDROMUL
BRONSIC
IMAGINI INDIRECTE
c4nsecinte ventiIat4rii
4bstr:ctie
c42pIeta F
ateIectazii
p:I24nare,
I4bare,
seg2entare
4bstr:ctie
inc42pIeta F
ateIectazie
inc42pIeta
hiperinfIatie
(air-trapping
c4nsecinte circ:Iat4rii
evanescenta
p:I24nara
D. SINDROMUL PARENCHIMATOS
= t4taIitatea inf4r2atiiI4r radi4I4gice privit4are Ia afecti:ni parenchi2at4ase
p:I24nare, care n: respecta terit4riiIe hist4I4gice definite anteri4r si, deci, nici
se2neIe sindr4a2eI4r respective: afecti:ni ne4pIazice / infIa2at4rii necr4zante
. 2acr4n4d:Ii s4Iitari intraparenchi2at4si
:nic
-0330
sancr: de in4c:Iare
t:berc:I42
infiItrat t:berc:I4s
caverna neevac:ata
chist hidatic
t:24ri p:I24nare benigne:
aden42
ha2art42
abces p:I24nar neevac:at
aspergiI4za
siIic4za
he2at42 p4sttra:2atic
infarct p:I24nar
angi42 p:I24nar
n4d:I re:2at4id
infiItrat f:gace
2,30
cancer br4nsic
2etastaza p:I24nara :nica
2:ItipIii
-0330
t:berc:I4a2e
infiItrate t:berc:I4ase
caverne neevac:ate
chiste hidatic
t:24ri p:I24nare
benigne: aden42at4za
abcese p:I24nare
neevac:ate
aspergiI4za
siIic4za
infarcte p:I24nare
n4d:Ii re:2at4izi
infiItrate f:gace
2,30
cancer br4nhi4I4-aIve4Iar
2etastaze p:I24nare
t:berc:I42
InfiItrat e4zin4fiIic
ha2art42
aspergiI4za
Caractere de benignitate
Caractere de 2aIignitate
Wc4nt:r
Wdi2ensi:ni
WIezi:ni as4ciate
2etastaze p:I24nare 2:ItipIe
Chiste hidatice 2:ItipIe
D. SINDROMUL PARENCHIMATOS
2. cavitati intrap:I24nare
c: pereti gr4si
abces p:I24nar partiaI/t4taI
evac:at
caverna t:berc:I4asa recenta
cancer p:I24nar I excavat
2etastaze excavate
aspergiI42 p:I24nar excavat
chsit hidatic partiaI / t4taI
evac:at
c: pereti s:btiri
chist aeric
pIa2an p4Iichistic
b:Ie de e2fize2
pne:2at4ceIe
br4nsiectazii
abcese , caverne vechi
Abces p:I24nar. Hidr4pne:24t4rax
Cancer p:I24nar excavat
E. SINDROMUL VASCULAR
C7.ulata pulmonulu:
nut7tva
apa7tnand ma7 .7.ulat
Ao to7a..a aa. .. aa b7ons.e
fun.tonala apa7tnand m. .7.ulat
aa vzble Rx pana la manta
vv: t7ae.t o7zontal, 7amf.ate
late7ala
.apla7e: no7mal nevzble, n
manta
debt ma7e, p7esune m.a,
7ezstenta pe7fe7.a m.a,
.omplanta ma7e
va7at p7esonale f.te de
g7avtate, tmpul 7esp7ato7
(7edst7buta vas.ula7a no7mala)
Sd7. vas.ula7
p7e.apla7
.apla7
post.apla7
E. SINDROMUL VASCULAR precapiIar
c: hipervasc:Iarizatie = hipere2ie p:I2.
bol .u sunt sstem.o-pulmona7 (DSA)
hpe7voleme (R .u sd7. nef7ot.)
hpe7.hneze (hpe7t7odsm)
Rx:
7edu.e7ea t7anspa7ente pulmona7e
.7este7ea g7osm desenulu pulmona7
absenta snd7omulu alveola7 sau nte7sttal
a7te7a pulmona7a n hl de dmensun
.7es.ute
c: hip4vasc:Iarizatie = 4Iighe2ie
blate7al (tet7aloga Fallot)
unlate7al (stenoze de a7te7a pulmona7a
.ongentala sau dobandta ;ex:sd7. M. Leod)
Rx:
hpe7t7anspa7enta pulmona7a dfuza
desen pulmona7 g7a.l
hl G, da7 uneo7
hipertensi:ne p:I24nara precapiIara
spasm a7te7ola7 de p7ote.te a segmentulu dn
aval
Rx:
hl, vase pe7hla7e dlatate, amputate .u
7edu.e7ea desenulu vas.ula7 n pe7fe7e
(unde plamanul apa7e hpe7t7anspa7ent)
dlata7ea .avtatlo7 .a7da.e d7epte
E. SINDROMUL VASCULAR capiIar
Cauze:
.omp7omte7ea patulu .apla7 p7n
p7o.ese de fb7oza nte7sttala
hpe7nflate alveola7a
Rx:
sd7. nte7sttal b7ons.
hpe7tensune pulmona7a
E. SINDROMUL VASCULAR p4stcapiIar
= staza ven4asa p:I24nara
afe.tun .e blo.heaza ntoa7.e7ea
sangelu sp7e AS
. ac:ta
p7n nsuf.enta vent7.ula7a
stg a..
Rx:
sd7. alveola7 = EPA
2. cr4nica
p7n a.umula7e pasva de
sange n te7to7ul venos
Rx.:
7edst7buta vas.ula7a
edem nte7sttal: ln e7ley,
desen 7et.ula7, m.7onodul
edem alveola7 n a7le
pulmona7e nep7otejate; nu se
ma p7odu.e odata .u apa7ta
HTP
TUMORILE PULMONARE
Cea 2ai frecventa si 2ai i2p4rtanta t:24ra pri2ara a pIa2in:I:i
este CARCINOMUL BRONSIC
Frecventa : ma ma7e la ba7bat, da7 n.denta la feme
este n .7este7e.
Incidenta : 40-70 an ; neobsnut sub 30 an.
Eti4I4gie :
.el ma mpo7tant: fumatul 7s.ul este pp .u n7. de tga7
polua7e atmosfe7.a
anumte o.upat lu.7ato7 .u azbest, substante 7adoa.tve,
anumte .hm.ale, n.luznd mnele de u7anu, hematta, .7omat,
n.hel, a7sen.,
fumato7 .u expune7e la azbest au un 7s. .7es.ut fata de
fumato7 fa7a expune7e la azbest.
CARCINOMUL BRONSIC - Anat424pat4I4gic
.a7.nomul .u .elule s.uamoase
(epde7mod) : 30-50 %
adeno.a7.nom (n.luznd s
.a7.nomul alveola7) : 15-35 %
.a7.nomul anaplast. .u .elule
ma7:10-15 %
.a7.nomul .u .elule m.: 20-30 %
unele .an.e7e pulmona7e nu se pot
n.ad7a pe7fe.t n a.este .atego7,
avnd .omponente .e .o7espund ma
multo7 tpu7, de ex. .a7.nom
adenos.uamos
alte tumo7 7a7e sunt .lasf.ate
sepa7at, de ex. .a7.nom .u .elule
.la7e, .a7.nom .u .elule bazale s
.a7.no-sa7.omul.
1.Can.e7ul .u .elule s.uamoase
.ent7al
.7este 7elatv n.et
ex.aveaza ma f7e.vent .a
alte tpu7
2.Adeno.a7.nomul :
pe7fe7. de ob.
uneo7 pe plamn fb7os
ex.aveaza ma 7a7
3.Tumo7a .u .elule m. :
a7e 7ata de .7este7e .ea ma
ma7e
de ob.e la p7ezenta7e a7e s
dete7mna7 se.unda7e
.ent7ala de ob.
aso.aza tp. adenopat
medastnale sau hla7e
7a7 ex.aveaza
Ap7ox. 50% dn .an.e7e apa7 .ent7al (n sau p7oxmal de b7onhle
segmenta7e)
tumo7a apa7e la nvelul mu.oase b7ons.e s nvadeaza pe7etele b7ons.
poate .7este n ju7ul b7onhe s de asemenea n lumenul b7onhe
F obst7u.ta du.e la atele.taze deseo7 la nfe.t n plamnul dstal de tumo7a
Tumo7le pe7fe7.e
apa7 .a nodul de "pa7t mo sau mase ne7egulate
nvadeaza tesutu7le ada.ente
semne de .olaps sau .onsolda7e pot apa7e, da7 sunt ma putn evdente fata de
tumo7le .ent7ale
Ambele tpu7 (.ent7al sau pe7fe7.) pot aso.a :
adenopat medastnale sau hla7e (.eea .e poate .onsttu .auza de obst7u.te a
.alo7 ae7ene .ent7ale)
ne.7oza .ent7ala F ex.avat
tumo7le pe7fe7.e pot apa7e n zone .u ..at7. (.unos.ut fnd .a fb7oza
p7edspune la modf.a7 neoplast.e)
metastaze de la .an.e7ul pulmona7 pot apa7e o7unde n .o7p, da7 .ele ma
.omune lo.u7 sunt : ggl. hla7, medastnal, sup7a.lav.ula7 , f.at, oase,
.7ee7, glande sup7a7enale s pele
.an.e7ul pulmona7 este o .auza .omuna de lmfangta .a7.nomatoasa
CARCINOMUL BRONSIC
La7g7ea hlulu
n tumo7a .ent7ala =
manfesta7ea nsas a tumo7
+- adenopat
n tumo7a pe7fe7.a =
adenopat
afe.ta7ea 7eala a hlulu este
ap7e.ata p7n CT sau RM
CT: 7ezolute ma buna
RM: .ont7ast natu7al ma bun
fa7a .ont7ast .v.
CARCINOMUL BRONSIC - se2ne Rx
Obst7u.ta .alo7 ae7ene
atele.taze dstal de tumo7a:
segmenta7a loba7a a
nt7egulu plamn
pneumone dstal de obst7u.ta
b7ons.a, se.unda7a a.estea,
fa7a b7onhog7ama ae7ana
p7ezenta, putnd a.ope7 tumo7a
(suspe.tata da.a pneumona nu
se vnde.a .u t7atament .o7e.t)
atele.taze n.ompleta
hpe7nflate
CARCINOMUL BRONSIC - se2ne Rx
Mase periferice
2asa periferica + Iargire a hiI:I:i +
2etastaze 4s4ase = cancer
daca 2asa periferica este sing:r:I
eIe2ent an4r2aI F diagn4stic:I
diferentiaI dificiI, 2ai aIes ca n: exista
se2ne radi4I4gice sig:re de
diferentiere intre benign si 2aIign.
T4t:si :
n4d:I:I 2aIign este 2ai 2are Ia
prezentare decit :n:I benign
prezinta c4nt:r extern dif:z,
I4b:Iat sa: 42biIicat, spic:Iat
p4t exista n4d:Ii sateIiti
f4r2ati:nii principaIe : 2ai
frecvent in t. benigne, dar p4t fi
as4ciate si c: cancer:I
caIcificariIe dif:ze sa: centraIe
intr-4 2asa periferica s:nt
s:gestive ptr. Iezi:ni benigne, dar
4cazi4naI 4 t:24ra 2aIigna p4ate
inghiti :n gran:I42 caIcificat
rata de crestere : 4 t:24ra 2aIigna
se d:bIeaza in - I:ni, a.i. :n
n4d:I care n: isi schi2ba
di2ensi:niIe in 2 ani p4ate fi
c4nsiderat benign
CARCINOMUL BRONSIC - se2ne Rx
Mase pe7fe7.e
ex.ava7e :
10-15% n .an.e7ul pe7fe7. pe
7g7.
ma bne demonst7ata pe CT
dato7ata ne.7oze .ent7ale sau
fo7ma7 de ab.es se.unda7
obst7u.te b7ons.e
+- nvel de l.hd
pe7etele .avtat este de ob.e
g7os s .u .ontu7 nte7n ne7egulat,
nodula7, da7 uneo7 apa7e subt7e
b7onhog7ama ae7ana
uneo7 n adeno.a7.noame,
obsnut n .a7.nomul alveola7
CARCINOMUL BRONSIC - se2ne Rx
CARCINOMUL BRONSIC
- Cancer:I virf:I:i p:I24nar (Panc4ast
Rx
masa sau doa7 ng7osa7e
pleu7ala + dst7u.te osoasa
(.oaste, ve7teb7e, et..)
- nvadeaza plexul b7ahal s ggl.
smpat. .e7v.al nfe7o7 - .el ma
bne demonst7at p7n CT s RM
CT
bun n spe.al pt7. nte7esa7ea
osoasa
RM
se.tunle n plan .o7onal s
sagtal .a7e demonst7eaza
7apo7tu7le tumo7 .u plexul
b7ahal s vasele
sub.lav.ula7e
pt7. nvada7ea g7asm
ext7apleu7ale
E.hog7afa
p7n fosa sup7a.lav.ula7a pt7.
bopse pe7.utanata
Interesare 2ediastinaIa
aden4patiiIe 2ediastinaIe apa7 tp. n
.an.e7ul .u .elule m., da7 poate apa7e s
n .elelalte .an.e7e b7ons.e
= 2ediastin:I apare Iargit, p4IicicIic
adenopatle sau tumo7a .ent7ala pot
afe.ta es4fag:I t7anzt esofagan
ba7tat : .omp7ese sau nvaze
afectarea nerv:I:i frenic : hemdaf7agm
sus stuat (poate f dete7mnat s de
atele.taze afe.tune subf7en.a), .u
ms.a7e pa7adoxala(fluo7os.ope sau
e.hog7afe)
4bstr:ctia venei cave s:peri4are :
CT, RM
nvaze a pe7.a7dulu p7n adenopat sau
de .at7e tumo7a p7ma7a: pericardita sa:
revarsat pericardic
invazie a atri:I:i sting : CT, RM
CARCINOMUL BRONSIC
Interesare pIe:raIa
revarsat:I pIe:raI poate
apa7e p7n
nvaze d7e.ta
obst7u.te lmfat.a
se.unda7 une pneumon
obst7u.tve
.a 7aspuns la p7ezenta
tumo7
:ne4ri pne:24t4rax
dato7ta une tumo7 ex.avate
subpleu7ale
Metastaze p:I24nare
Ii2f4gene (.a7.noza mla7a,
lmfo.a7.nomatoza)
he2at4gene (m.7onodula7e,
nodula7e, ma.7onodula7e)
CARCINOMUL BRONSIC
Interesare 4s4asa
.a7.nomul pe7fe7. poate
invada c4asteIe sa: c4I4ana
direct
2etastazeIe he2at4gene
4s4ase s:nt de 4b.
4ste4Iitice + du7e7e
( depstate p7e.o.e p7n
s.ntg7afe osoasa)
du7e7 osoase, n spe.al la
nvelul pumnulu, glezne,
mn, p.oa7e sunt dato7ate
4ste4artr4patiei hipertr4fice
pe 7g7. se .t. pe7ostoza
bne delmtata
s.ntg7afa poate f poztva
nantea modf.a7lo7 7g7.
CARCINOMUL BRONSIC
- F7e.venta .7es.uta
- Polmo7fsm lezonal
- Anatomo-.ln.:
1.Tb. p7ma7a = p7monfe.ta
2.Tb. se.unda7a = 7enfe.ta 7ea.tva7ea
Va7sta .opla7e
= C42pIex:I pri2ar
1. Afe.t p7ma7 = san.7u de no.ula7e
= fo.a7 de alveolta
2. Lmfangta spe.f.a
3. Adenopate hla7a sau medastnala
Ev4I:tia afect:I:i pri2ar:
Reso7bte
Fb7oza
Cal.f.a7e
Cazef.a7e : .ave7na p7ma7
tube7.ulom
TUBERCULOZA
.TUBERCULOZA PRIMARA
C42pIicatii
A. I4caIe
epit:berc:I4za = .ongeste pe7fo.ala
F opa.tate segmenta7a, omogena,
ntenstate m.a
pri24infectia extensiva, .azeoasa =
pneumone .azeoasa F opa.tate
loba7a segmenta7a, ntenstate mede
caverna pri2ara
c42pIicatii br4nsice sa: pIe:raIe
B. dise2inare br4nh4gena =
br4nh4pne:24nia t:berc:I4asa
C. dise2inare he2at4gena
2iIiara t:berc:I4asa
dise2inari pa:cibaciIare
Ia niveI:I sept:riI4r / interstiti:I:i F
fibr4za
Ia apex:ri F n4d:Iii Si24n
.TUBERCULOZA PRIMARA
dn nodul Smon, n .ondtle s.ade7 7ezstente o7gansmulu
NFLTRATE TC
7otund = opa.tate ma.7onodula7a, ap.osub.lav.ula7a (exudatva)
nebulos = lezune exudatva + p7olfe7atva
evolute .ave7ne
TUERCULOAME
TC CAVTARA CU DSEMNAR
RONHOGENE fb7oza7e lezun
HEMATOGENE .azef.a7e p7otefo7me
TC FROCAVTARA
= fb7oza lezune na.tva
+ .ave7ne lezun n stad dfe7te de a.tvtate
2.TUBERCULOZA SECUNDARA