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  • Pneumoconioze: Boli Profesionale Date de Pulberi Inhalate

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    Gabriela Soiam
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    curs medi radio

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    PULMONAR 3

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    curs medi radio

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    93 views50 pages

    Pneumoconioze: Boli Profesionale Date de Pulberi Inhalate

    Uploaded by

    Gabriela Soiam
    curs medi radio

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 50

    PNEUMOCONIOZE

    Boli profesionale date de pulberi inhalate:


    SILICOZA…azbestoza;berilioza;sideroza,etc.

    SiO2 – particule < 3µ=>EVOLUTIE IN 3 STADII:


    DEBUT=st.I => STARE=st.II => TERMINAL=st.III
    -alveolita+ -st.I…+ -st.I+II+
    -noduli fibro-hialini -noduli gr.I-II; -macronoduli,tendinta la
    interstitiali + -adenopatii hilare + confluare in mase
    -emfizem -calcificari pseudotumorale

    COMPLICATII:-caverna silicotica;tbc;cancer bronsic


    A B

    SILICOZA : STADIUL II (A) SI STADIUL III (B)


    CAVERNA SILICOTICA

    SILICOZA ST III
    SARCOIDOZA
    Boala BESNIER-BOECK-SCHAUMANN=reticulo-endotelioza
    benigna. Evolueaza in 3 stadii:

    St.I:Adenopatii hilare bilat.,ggl.mici,neconfluati;

    St.II:Adenopatii+desen reticulo-nodular;

    St.III:Infiltrate perihilare”aripi de fluture”=>


    interstitiu+alveole+fibroza peribronhovascul.
    Confirmare diagnostic:Reactia KVEIM: Sarcoid Boeck=>I.D.R.=> +
    - Biopsie endoscopica=>trans-bronsica.
    SARCOIDOZA
    SARCOIDOZA

    TOMOGRAFIE PLANA

    Stadiul III
    CHISTUL HIDATIC
    PULMONAR
    Etiologie:Taenia equinococus;T.alveolaris(rara):filtrul II.
    CHP NECOMPLICAT:-macronodul opac gr.II-III;contur net
    (“tras cu compasul”),ovoid,ax >cranio-podal;”plasticitate”
    respiratorie;compresibil pe plan dur(diafragm,coaste,cord).
    Dg.dif.=cancer periferic nodular. (CT,echografie).
    CHP COMPLICAT:-a)Fisurat:comunicare bronsica=>semn
    MORQUIO(decolarea membranelor,semiluna aerica);b)Rupt:
    imag.hidro-aerica,nivel lichidian ondulat(s.membr.ondulate,
    “valuri”,”nuferi”);membr.retinute(“cocolos hirtie”,”limba de
    clopot”).3)Diseminat:-hidatidoza secundara(macronod.bilat.)
    CHIST HIDATIC NECOMPLICAT
    A B

    CHIST HIDATIC PULMONAR


    TOMOGRAFIE PLANA

    CHIST HIDATIC
    Chist hidatic
    complicat:
    fisurarea

    SEMNUL SEMILUNEI AERICE


    CHIST HIDATIC COMPLICAT:
    RUPTURA CHISTULUI
    CHIST HIDATIC COMPLICAT:
    ruptura si pneumonia alergica
    CHISTURI
    HIDATICE
    MULTIPLE
    PLAMANUL CARDIAC
    STAZA in mica circulatie=Hipert.Pulm.primara/secundara=>
    valvulopatii mitrale,mitro-aortice,HTA,pericardita constrictiva
    insufi.cardiaca globala.
    EDEM PULMONAR:
    Rx.:-silueta cardiaca patologica (st.mitrala..);
    -redistributie apicala a fluxului;
    -desen hilar accentuat,fluu;
    -miliara cardiaca=hemosideroza;
    -staza limfo-venoasa=linii Kerley B;
    -fibroza interstitiala
    PLAMAN CARDIAC

    EDEM PULMONAR ACUT=URGENTA MEDICALA !!


    Depasirea capacitatii interstitiului si capilarelor=>transsudat
    alveolar=>inundatie alveolara.

    Rx.:-opacitati bazale crescatoare rapid cranial;aspect nouros,


    “vatos”,vag nodular,amorf,nesistematizat,perihilar bilateral.
    -pleurezie =transsudat-bilaterala;
    -cardiomegalie+semne clinice de insuf.cardiaca.
    Dg.dif.:-alte cauze de edem pulm.acut:toxic,gaze etc.=>cordul
    normal.
    EMBOLIA & INFARCTUL PULMONAR
    U R G E N T A MEDICALA !!

    Definire:obstr. ac.=> ram art.pulm.cu mat.embolic migrat.


    Etiologie:-tromboflebita m.inf.,pelvis,v.cava;
    1)STADIUL PRECOCE: Rx:-pulmon normal,sau proemina
    conul art.pulm; hipertransparenta sistemat.; Scintigr.perfuzie:
    =zona hipo/afixatoare; Angio pulm.:amputatie=obstr.ram a.p.
    absenta vasc.infra-tromb;Rad.interventionala:-cateterism
    selectiv ram tromboz.+perfuzie fibrinolitica (Uro/StreptoKinaza);
    -pulverizare mecanica+aspirare-catetere speciale.
    Embolii multiple,iterative=boala tromboembolica=HTP=cor P.C.
    2)STADIUL TARDIV=INFARCT:opacitate sist.”pneumonia
    like”;banda;nodular-ovala;complicatii:excavare,abcedare
    AFECTIUNI PLEURALE
    1)PLEUREZII:-Transsudat=>insufic.cardiaca.
    -Exsudat=>inflamator,neoplazii etc.
    A. PLEUREZIA MARII CAVITATI:-mica,medie,mare,ma-
    siva(hidrotorax).Rx.:opacitate omogena decliva gravitational
    dependenta;curba Damoiseau.
    B. PLEUREZII INCHISTATE:scizurala orizontala,oblica:
    Rx:-opacit.ovoida,fuziforma;diafragmatica: ascensionare
    diafragm,obturare gastrica;mediastinala:largire in banda, ”
    echer” (mediast+diafragm );axilara:banda opaca  cu
    peretele axilar;
    C. SECHELE PLEURETICE=PAHIPLEURITE:
    -fibroase,fibrocalcare=>placarde,”platosa”,”cuirasa”.Rx.:
    opacit.banda,calcif.amorfe,retractii costale,”corturi”diafrag
    matice,simfize/imobilizare diafr.,deviere mediastin,col.vert.
    A B
    PLEUREZIA MARII CAVITATI:cantitate mica (A);
    cantitate mare (B)
    PLEUREZIA MARII CAVITATI
    PLEUREZII
    INCHISTATE
    INTERLOBAR
    PLEUREZII INCHISTATE DIAFRAGMATIC
    PLEUREZII
    INCHISTATE:

    PLEUREZIA
    MEDIASTINALA
    SECHELE POST-PLEUREZIE
    PAHIPLEURITA CALCARA
    AFECTIUNI PLEURALE
    2)PNEUMOTORAX. TOTAL/PARTIAL
    Etiologie:spontan (astm !),accidental (trauma),iatrogen=>Dg
    & terapeutic.Tipuri:-endogen (bula emf.,caverna);exogen=>
    plaga,fract.cost.;iatrogen(acc.punctie,dg/terap).

    Tipuri anat/radiologice:-in pleura libera=>colaps la hil;


    -in pleura simfizata=>colaps limitat
    Dg.Rx:-absenta desen pulmonar;hipertransparenta;
    -linia bordanta pleurala viscerala;
    -bont pulmonar colabat la hil,opac;
    COMPLICATII:-hidro-pneumotorax
    -pio/hemo-pneumotorax.
    PNEUMOTORAX HIDRO-PNEUMOTORAX
    PIO-PNEUMOTORAX

    STAFILOCOCIE PLEURO-PULMONARA
    TUMORI PLEURALE
    Histopatologie:-Endo/mezoteliom;sarcom;metastaze.

    SEMNE RADIOLOGICE :-noduli opaci marginali +


    -epansament pleural variabil,
    hemoragic;
    Dg.dificil…CT;ecografie;PLEUROSCOPIE & biopsie;
    PUNCTIE-BIOPSIE ghidata imagistic
    TUMORA PLEURALA:MEZOTELIOM
    MEDIASTIN:DG.IMAGISTIC
    METODE SI TEHNICI:
    CT=metoda standard “de aur”
    (gold standard);
    Rgraf. PA/AP/Digital rad.; esof.baritat;
    tomo plana;
    IRMN;
    eco trans-esofagiana,transcard./abd.
    Cavografie sup.; angiocardiografie
    Lawrence M. Witmer
     Mediastinul anterior:
    timus, tesut gras, limfatice
     Mediastinul mijlociu:

    inima, pericardul, aorta, traheea, bronhiile


    principale, limfatice
     Mediastinul posterior:

    aorta descendenta, esofagul, vv. azygos,


    lanturile simpatice laterovertebrale, canalul
    toracic
    Lawrence M. Witmer
    MEDIASTIN:PATOLOGIE
    I.ADENOPATII MEDIASTINALE Frecventa 

    Clasificare: A.NETUMORALE:-tbc primara=>adenita


    -sarcoidoza;
    -silicoza;
    -Sd.LÖFGREN
    B.TUMORALE: -limfom=>Hodgkin,non-H;
    -leucemie limf.cr.;
    -metastaze:seminom,sin,pulm.
    Aspecte Rx:COMUNE:Adenomegalia tumorala mediastinala
    =largire mediastin sup/ant.+hil :contur policiclic,net;viscerali
    zarea=>infiltrat perihilar,macronoduli (st.IV);
    Nu exista discriminare etiologica RX !!
    Stadializarea clinica (I-IV)=eco /CT abdominal (adenopatii RP)
    ADENOMEGALII TUMORALE:
    LIMFOM MEDIASTINAL

    Radiografie cu raze dure


    CAVOGRAFIE SUPERIOARA

    ADENOPATIE TUMORALA MEDIASTINALA


    LIMFOM
    MALIGN
    Stadiul IV
    LIMFOM MALIGN NON-HODGKIN:
    invazie pericardica demonstrata prin CT
    F.EXP. NE-GANGLIONARE
    A).MEDIASTIN ANTERIOR
    1.SUPERIOR: a)Tiroida: gusa plonjanta: nodul opac -trapez
    calcificari; cancer ; adenoame;
    b)Timus: retrosternal: hipertr.(copil);timom=adult
    2.MIJLOCIU: a) Disembrioame heteroplastice (mono/di/tri-
    dermice): lichidiene,uniloculare,contur net (“chisturi”); CT=
    caract. structurale densimetrice (fanere,dentina,grasime);
    b)Disembrioame homoplastice:chist celomic(pleuro-peri-
    cardic):opacitate macro nodulara in sin.cardio frenic dr.,
    contur net.
    GUSA PLONJANTA-RETROSTERNALA
    HIPERTROFIA TIMUSULUI

    BILOBARA UNILOBARA
    F.EXP.NE-GANGLIONARE
    B.)MEDIASTINUL MIJLOCIU

    1.Chist bronhiogenic:-bronsie oarba, supranumerara=>


    nodul opac parahilar; rar im. hidroaerica.
    2.Disembrioame

    C.)MEDIASTINUL POSTERIOR
    TUMORI NEUROGENE: schwanom,neurofibrom,ganglio-
    neurinom,simpatoblastom(neuroblastom malign);
    Aspecte Rx.:-macronodul,contur net,sediu sant costo-verte-
    bral,extensie pulmonara ;modificari osoase tipice:
    -eroziuni gaura conjugare vert.;eroziuni costale adiacente
    Tomografie sagitala

    TUMORA
    MEDIASTINALA
    NEUROGENA
    TUMORA MEDIASTINALA NEUROGENA

    Radiografie
    digitala

    Computer tomografie
    III.ALTE F.EXP.MEDIASTINALE

    1.VASCULARE:-ANEVRISME:-aorta,a.pulm.,v.stg.
    Dg.:-fluoroscopie=>pulsatii,expansiune sistolica;
    -ecocardiografie;
    -angiocardiografie:angio-RMN;angio-CT.
    2.DIGESTIVE:-a)autohtone:-megaesofag/achalazia cardiei;
    -diverticuli/tumori esofag;
    b)heterotope -abdominale:-hernie hiatala;
    -hernii/eventratii diafragmatice
    Dg.:fluoroscopie=>Bariu-pasaj eso-gastro-duodenal
    ALTE FORMATIUNI EXPANSIVE MEDIASTINALE

    ANEVRISM DE AORTA Tumora


    vertebrala
    FORMATIUNI EXPANSIVE MEDIASTINALE

    A
    A

    ANEVRISM DE ARTERA PULMONARA


    FORMATIUNI
    EXPANSIVE
    MEDIASTINALE
    anevrism

    ANEVRISM DE
    VENTRICUL
    STING
    ALTE FORMATIUNI EXPANSIVE MEDIASTINALE

    Cancer esofagian=>extins loco-regional

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