PATOLOGIE PULMONARA

RADIO – IMAGISTICA-2

Rad/Imag-Iasi-2003
Patologie bronsica
DISPLAZII CHISTICE
B.P.O.C.
BRONSIECTAZII
BRONHOCEL
MUCOVISCIDOZA
CORPI STRAINI TRAHEO-BRONSICI
CANCER BRONHO-PULMONAR
 Displazii chistice
Definitie:
Definitie:malformatii
malformatiicongenitale
congenitaleale
alemugurelui
mugureluibronsic
bronsic
terminal
terminal(bronsiolar).
(bronsiolar).
CHISTUL
CHISTULSOLITAR
SOLITAR
BOALA
BOALAPOLICHISTICA
POLICHISTICAPULMONARA:
PULMONARA: cu culocalizare
localizare
segmentara,
segmentara,lobara,
lobara,pulmonara
pulmonara
Descriere
Descriereradiologica
radiologica::
--hipertransparenta
hipertransparenta, ,perete
peretefin;
fin;
--ininplamin
plaminpolichistic
polichistic––efect
efectasupra
asupraelemente
elementelor
loranatomice
anatomice
vecine
vecine=>=>schelet,
schelet,mediastin
mediastin
Pulmon : patologie bronsica
 Patologie bronsica

CHISTURI AERIENE :tipul SOLITAR

Rad/Imag-Iasi-2003
Boala segmentara
Plamin polichistic

CHISTURI AERIENE
MULTIPLE

Displazie congenitala
CHISTURI
AERIENE:
MULTIPLE,
ABCEDATE
 B.P.O.C. = Afectarea bronsiilor mici

1 BRONSITA CRONICA:
Radiografie toracica:
- desen pulmonar hilio-bazal accentuat;

2 EMFIZEM PULMONAR:
Distensie;- hipertransparenta (ruperea peretilor alveolari si
distrugerea patului capilar)+ hiperinflatie

3 ASTM BRONSIC INTRICAT ( CRONIC INFECTIOS):

Inflamatie parietala; dopuri de mucus; bule de emfizem;
adesea combinatie cu 1 si 2.
BRONSITA CRONICA: bronhografii
Patologie bronsica
ULCERATII
“NISE” PARIETALE

BRONSITA DEFORMANTA
EMFIZEM PULMONAR
BRONSIECTAZII = dilatatii bronsice

A CONGENITALE:- sindroame malformative complexe:

Sdr. KARTAGENER:- situs inversus, etmoido-antrita
(surditate)
- bronsiectazii chistice
Sdr. MUNIER - KÜHN:- idem, fara situs inversus
B DOBINDITE: - secundare altor afectiuni
(tractiuni parietale externe)
Radiografie:
-dilatatii bronsice pline - ”ciorchine”, cordoane
- dilatatii bronsice goale - rozeta, fagure, lemn mîncat de carii
-  bronsiectatic hilio-bazal
CT - dilatatii cilindrice, chistice,ampulare,
sacciforme, moniliforme
 Triunghiul bronsiectatic

BRONSIECTAZII BILATERALE
Bronsiectazii
BRONSIECTAZIE: “ROZETA”
 BROHOGRAFIE

BRONSII NORMALE BRONSIECTAZII

 BRONSIECTAZII
tipuri anatomo-radiologice
 CANCER BRONHO-PULMONAR
Cea mai frecventa localizare neoplazica

FUMATUL
Histopatologie: - carcinom epidermoid (squamos);
adenocarcinom; celula mica (“oat cells”); sarcom.
Anatomo-radiologic: - bronsii mari (central)
- bronsii mici (periferic)
- alveolar (rar).
Sediul fata de lumen: - endobronsic - atelectazie;
- exobronsic - nodul
- endo si exobronsic – atelectazie + nodul
 ROLUL IMAGISTICII
EVIDENTIAZA TUMORA: radiografie toracica, CT
Aspecte:
-cancer central (hilar ) endobronsic
- emfizem sistematizat (rar)
- atelectazie (segment, lob, pulmon) - dg.diferential: pneumonie;
-cancer central (hilar ) exobronsic
- nodul opac hilar + prelungiri radiare
dg.diferential: adenopatie, anevrism artera pulmonara;
-cancer periferic, nodular
- nodul opac gr.II- III, contur neregulat (prelungiri)
intensitate mare.
- dg.diferential: chist hidatic, tuberculom, hamartom.
CANCER BRONHO-PULMONAR
CANCER ENDOBRONSIC
CANCER EXOBRONSIC
CANCER NODULAR PERIFERIC
 ROLUL IMAGISTICII
STADIALIZARE
Metode:- CT, IRM, US.
Extensia locala:
-extensia mediastinala - stenoza, tromboza VCS;
- invazie pericard - pericardita - ecocardiografia
-extensia parietala – pleura, coaste; apex - Sdr. Pancoast-
Tobias;
- extensia lobara - cancer lobar
ADENOPATII
METASTAZE
OS - scintigr.Tc99; CREIER - IRM,CT; FICAT,SR – US, CT
CANCER EXTINS LOBAR
Sindrom Pancoast - Tobias

Cancer bronhopulmonar
periferic apical sting cu
distructia arcurilor costale
I - IV si a vertebrelor T1-
T4
CANCER BRONHO-PULMONAR: extensie parietala
 CANCER PULMONAR METASTATIC
MODALITATI DE DISEMINARE:
- HEMATOGENA: noduli opaci gr.II-III, diseminati anarhic,
bilateral, inegali, contur net, forma rotunda.
Cauta: cancer primitiv teritoriul cav: sin, testicul, rinichi,
os, prostata
- LIMFATICA: limfangita: diseminare peribonho -
vasculara / interstitiala parenchimatoasa: opacitati lineare,
micronoduli perihilar/ hilio - bazal bilateral; asociere cu
pleurezie. Cauta: sin, pancreas, stomac
- MIXTA: “miliara carcinomatoasa”: diseminare in
interstitiu, limfatic si hematogen: micronoduli diseminati bilateral
Cauta: sin, tiroida, digestiv

Dg.diferential:bronhopneumonie, hidatidoza, miliara

tbc; silicoza, viroze, colagenoze
METASTAZE PULMONARE TIP HEMATOGEN
METASTAZE PULMONARE
PNEUMOPATII INFLAMATORII
ACUTE: -BACTERIENE:
-BACTERIENE SUPURATIVE;
-VIRALE (“ATIPICE”);

CRONICE: -TUBERCULOZA;
-Alte boli cu componenta
inflamatorie
 PNEUMONII MICROBIENE
Pneumonia lobara
Etiologie: - infectia cu pneumococ
Sindrom de umplere alveolara - faze:
-congestie - VOAL (debut)
-hepatizatie - (perioada de stare) -  opac, segment,lob
- rezorbtie:- omogena = atenuare sincrona
- neomogena = “tabla sah”;
- de la centru spre periferie;
- de la periferie spre centru
Complicatii:-pleurezii: para / metapneumonice
-abces
SEGMENTATIA PULMONARA
1 segment apical
2 segment posterior
3 segment anterior
3x segment axilar
4 segment postero-extern
5 segment antero-intren
6 segment FOWLER
7 segment bazal medial
8 segment bazal anterior
9 segment bazal lateral
10 segment bazal posterior
Plamin sting: 2b segment apico-dorsal
Lingula: - 4b segment superior
- 5b segment inferior
 LATERAL

PNEUMONIE BACTERIANA LOB MEDIU:

segment postero - extern
PNEUMONIE BACTERIANA LOB MEDIU
 Segment axilar

PNEUMONIE BACTERIANA LOB SUPERIOR

PNEUMONIE BACTERIANA PLURISEGMENTARA
FOWLER

LINGULA

FOCARE PNEUMONICE
MULTIPLE
 Pneumonie lobara Atelectazie

PNEUMONIE LOBARA: diagnostic diferential

 BRONHOGRAMA AERICA

PNEUMONIE BACTERIANA
PNEUMONIE
BACTERIANA
REZORBTIE
 BRONHOPNEUMONIA
Etiologie: streptococ, pneumococ, E.coli
Frecventa : nou nascut, batrin, imunodeficienta;
Histopatologie: -noduli bronhiolo-alveolar: - mici (acin);
- mari (lobul);
Aspecte radiologice: - noduli 1-10 mm
- diseminare bilaterala;
- respecta bazele si apexul;
- contur imprecis (congestie);
- centrul opac (bronsiola obstruata);
- nodulii confluiaza-aspect pseudolobar
- asincronism evolutiv;

Forme specifice:-tbc: evol.subacuta, noduli excavati, caverne

-stafilococica: pneumatocele, complicatii
supurative (piotorax, abcese multiple)
BRONHOPNEUMONIE
BRONHOPNEUMONIE
BRONHOPNEUMONIE

FORMA PSEUDOLOBARA
 Pneumopatii acute supurate
ABCESUL PULMONAR
Etiologie: stafilococ, streptococ, pneumococ, amoebian etc.
Patogenie: - bronhogen (aerogen, abcedarea pneumoniei);
- hematogen (septicopioemie);
- contiguitate (plagi, fracturi, post-operator);
Anatomie radiologica:
- stadiu pre-supurativ (pre-vomica): bloc pneumonic atipic,
”amputat”; opacitate centrala intensa,
nodulara;
- stadiu supurativ (post-vomica): -recent:”gura de cuptor”- imagine
hidro-aerica cu nivel inalt, liniar, neted si congestie in
jur;
-vechi: cronicizare (sapt.) - nivelul lichidian si congestia scad, inel
opac periferic, gros (membrana piogena), cavitate cu perete
rigid.
- complicatii: piotorax; pio-pneumotorax.
Evolutie: - vindecare; sechele fibroase;
ABCES
ABCESPULMONAR:
PULMONAR:faza
fazapre-vomica
pre-vomica
 Nivel
hidroaeric

pneumonie

pleurezie

ABCES PULMONAR SECUNDAR

ABCES PULMONAR SECUNDAR PNEUMONIEI
 ABCES
ABCES
PULMONAR
PULMONAR
IN
INFAZA
FAZACRONICA
CRONICA
““CHIRURGICAL”
CHIRURGICAL”
 Pneumopatii acute supurate
STAFILOCOCIA PLEURO-PULMONARA
Copil 0-1 an; SIDA; alte imunodeficiente
Anatomie radiologica: - noduli bronhopneumonici;
- pneumonie extensiv/ agresiva;
- abcedare
- pneumatocele gigante;
- pleurezii purulente
- piopneumotorax
Evolutie: grava, rapida (ore).

GANGRENA PULMONARA
Supuratie grava cu germeni anaerobi; asociata cu imunodeficienta;
Anatomie radiologica: focare pneumonice, necroze masive si abcese;
Imagini complexe: opacitati extinse, imagine hidro-aerice
multiple
 Dupa 24 h

1 2a 2b
SUPURATIE PULMONARA STAFILOCOCICA
 PNEUMOPATII ACUTE
NEBACTERIENE
PNEUMONII INTERSTITIALE, ATIPICE
Etiologie: virusuri: influenzae, paragripale, adenovirus, respirator
sincitial, myxovirus, mycoplasma pneumoniae, rujeolic,bacil
pertusis,
Ricketsia Burnetti, ornitoza, psitacoza
Patogenie: infectie aerogena (picaturi Pflüge) - bronsiolita;
infiltratie parietala bronsica, peribronhovasculara, limfangita;
edem bronsiolar,obstructie bronsica, mecanism de supapa;
atelectazii acinare, bule de emfizem.
Aspecte Rx:-infiltrat hiliobazal:  gripal Dittmar Rupert
-”aripi fluture”perihilar, reticulogranitat, noduli miliari
acinari (atelectazii acinare), bule de emfizem.
Complicatii: bronhopneumonie, pneumonie, pleurezii
TRIUNGHIUL DITTMAR RUPERT

PNEUMONIE
PNEUMONIEINTERSTITIALA:
INTERSTITIALA:GRIPA
GRIPA
PNEUMOPATII ACUTE
INTERSTITIALE

RUJEOLA

TUSE CONVULSIVA
PNEUMOPATII
PNEUMOPATII
ACUTE
ACUTE
INTERSTITIALE:
INTERSTITIALE:
COMPLICATII
COMPLICATII

BRONHOPNEUMONIE

PNEUMONIE
SEGMENTARA
TUBERCULOZA PULMONARA
Etiologie:
Bacil Koch (BK); cale contaminare: aeriana(Pflüge)
CLASIFICARE:

Tuberculoza primara(primoinfectia);
Tuberculoza secundara (ftizia)
Tuberculoza pulmonara primara

Copil: 2-7 ani, rar adolescent.

Anatomie radiologica: COMPLEX PRIMAR RANCKE:
afect primar => limfangita=> adenita
(sancru inoculare=alveolita acinara)
Complex integral = “in haltera”
Obisnuit este vizibila doar adenopatia satelita, paratraheala

EVOLUTIE: - 90% vindecare spontana, ad integrum

sechele cicatrici fibro-calcare; viraj tuberculinic - imunitate;
- 10% complicatii: miliara; bronhopneumonie;
pneumonie cazeoasa cavitara;
caverna primara (asociat adenopatie)
AFECT

ADENITA
LIMFANGITA

RANCKE
COMPLEX PRIMAR TUBERCULOS
COMPLEX
COMPLEXPRIMAR
PRIMARTBC TBCCOMPLICAT:
COMPLICAT:
congestie perifocala
COMPLEX
COMPLEXPRIMAR
PRIMARTBC
TBCCOMPLICAT:
COMPLICAT:
periadenita
periadenita
 ADENITA

COMPLEX
COMPLEXPRIMAR
PRIMARTBC
TBCCOMPLICAT:
COMPLICAT:
diseminarea
diseminareahematogena=
hematogena=miliara
miliaratbc
tbc
 ADENITA

COMPLEX
COMPLEXPRIMAR
PRIMARTBC
TBCCOMPLICAT:
COMPLICAT:
pneumonia
pneumoniacazeoasa
cazeoasa
SECHELE DUPA TBC PRIMARA:
NODULI FIBROSI APICALI SI
SUBCLAVICULARI;
CALCIFICARI IN PARENCHIM
SI GANGLIONII REGIONALI
TUBERCULOZA SECUNDARA
1 Noduli fibrosi apico-subclaviculari: potential ftizio-
geni(BK “dormant”=>reactivare); Rx=micronoduli tip
Simon, Aschoff-Puhl,Hedwall;reactivare - leziune
activa subclaviculara.
2 Infiltratul precoce subclavicular: alveolita exsudativa
nevindecabila spontan;Rx=nodul palid gr.II tip Assman(ro-
tund),Fleischner(oval),Redecker(patrulater),Dufour(nebulos
)
Evolutie:necroza - cazeificare - excavare - CAVERNA
Caverna recenta:”racheta de tenis”:infiltrat partial excavat cu
bronsie de drenaj inflamata;Caverna elastica:
hipertransparenta
circumscrisa,ax mare orizontal,pereti supli;Caverna scleroasa:
 FTIZIOGENEZA APICALA

Infiltrat precoce

ggl

NODULI
NODULIFIBROSI
FIBROSIAPICALI
APICALI=>POTENTIAL
=>POTENTIALFTIZIOGENI
FTIZIOGENI
 Infiltrat in curs de
excavare

Zile..saptamini

paleta

coada

INFILTRAT
INFILTRAT PRECOCE
PRECOCE TBC==>
TBC==>
==>
==> DEBUTUL
DEBUTUL FTIZIEI
FTIZIEI “racheta de tenis”
 Tomografie
Tomografieplana
plana

TUBERCULOM
TUBERCULOMAPICAL
APICAL
 DEBUT
DEBUTAL
ALFTIZIEI
FTIZIEIADULTULUI=CAVERNA
ADULTULUI=CAVERNA

Tomografie plana

TUBERCULOZA
TUBERCULOZACAZEOASA
CAZEOASACAVITARA
CAVITARA
TBC SECUNDARA=FTIZIA
TBC CAZEOASA -CAVITARA: caverna solitara; sisteme
de caverne (“miez de pîine”); pneumonie cazeoasa;
bronhopneumonie.
TUBERCULOMUL: nodul gr.II, intens, fibrocalcar =
infiltrat blocat cu potential de reactivare.
TBC FIBROASA: forme minore/ majore - FIBROTORAX
TBC HIPERCRONICA: caverne scleroase, fibroza exten-
siva, pahipleurite,bronsiectazii, emfizem.
Forme particulare: MILIARA adultului; PLEUREZIA.
COMPLICATII/SECHELE: HEMOPTIZIA; FIBRO-
TORAX; CORD PULMONAR CRONIC; AMILOIDOZA
 Diseminare
controlaterala

FTIZIE:
FTIZIE:CAVERNA
CAVERNAGIGANTA
GIGANTA
 -Sisteme de
caverne
-pneumonie

cazeoasa
lob inferior
sting

TUBERCULOZA EXTENSIVA CAZEOASA

 Tomografie
Tomografieplana
plana

Caverne,
Caverne,infiltrate,
infiltrate,fibroza
fibroza
TUBERCULOZA
TUBERCULOZACAZEOASA
CAZEOASACAVITARA
CAVITARA
FTIZIE;
FTIZIE;PNEUMONIE
PNEUMONIECAZEOASA
CAZEOASACAVITARA
CAVITARA
FTIZIE:DISEMINARE BRONHOPNEUMONICA
FTIZIE
FTIZIE:DISEMINARE
:DISEMINAREMILIARA
MILIARAIN
IN
TUBERCULOZA
TUBERCULOZASECUNDARA
SECUNDARA
 FIBROTORAX
FIBROTORAXTUBERCULOS
TUBERCULOS

FTIZIE
FTIZIEHIPERCRONICA
HIPERCRONICA&&SECHELARA
SECHELARA
ASPERGILOM -
caverna tuberculoasa
complicata micotic
Toracoplastie - metoda de tratament abandonata