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Determinari pulmonare in colagenoze si vasculite

Conf. Dr. Adriana Iliesiu

Poliartrita reumatoida.si Polimiozita .Colagenoze ‡ Grup de afectiuni cu anumite trasaturi comune: ± Cauza necunoscuta ± Afecteaza tesutul conjunctiv din organism ( polimorfism al manifestarilor clinice) ± Degenerescenta fibrinoida ± leziunea principala Pulmonar . Sclerodermia. Dermato.afecteaza mezenchimul. vasele sau ambele LES.

pericard) ‡ Rinichi ± HTA (crize hipertensive) si proteinurie .Sclerodermie = scleroza sistemica = boala cronica sistemica de cauza neprecizata ‡ Piele .fibroza cutanata ‡ Fenomen Raynaud ‡ Tract gastrointestinal90% scleroza esofagiana ‡ Cord ±(miocard.

Sclerodermie ± manifestari pulmonare ‡ Fibroza interstitiala ‡ HTA pulmonara .

Sclerodermie ± manifestari pulmonare ‡ Boala interstitiala pulmonara ‡ HTA pulmonara ‡ Pneumonie de aspiratie (reflux gastroesofagian) .

Lupus eritematos sistemic (LES) ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Manifestari sistemice Musculoscheletale Cutanate Hematologice Neurologice Cardiopulmonare Renale Gastrointestinale Oculare .

Lupus eritematos sistemic (LES) ‡ Pleurezie + pericardita ‡ Pneumonita lupica (dg. dif. cu infectia pulmonara) ‡ Fibroza interstitiala ‡ HTA pulmonara 30-50% 10% 5% <5 % .

oculare Osteoporoza .Poliartrita reumatoida ‡ Articulare ± sinovita articulatii periferice. neurologic) Pleuro-pulmonare Neurologice. simetrica ‡ Extra-articulare ± ± ± ± ± Noduli reumatoizi Vasculita reumatoida (cutanat.

complement) Fibroza pulmonara Noduli pulmonari (unici sau conglomerati) .Poliartrita reumatoida Pleurita ± lichidului pleural (glucoza.sd.Caviteaza ± pneumotorax sau fistula bronhopulmonara . Caplan : + pneuconioza ( fibro-noduli difuzi) HTA pulmonara .

Dermatomiozita si polimiozita ! Manifestare paraneoplazica ‡ Afectare interstitiala ‡ HTA pulmonara .

LES.Manifestari clinice ‡ ‡ ‡ ‡ Dispneea (SD. PR) Tusea Raluri crepitante Semne de HTA pulmonara .

Determinari pulmonare in colagenoze LES Afectare Interstitiala (alveolita fibrozanta) Bronsiolita obliteranta Pneumopatii nodulare Afectare pleurala Hemoragie alveolara Hipertensiune pumonara Sclerodermie Desmatomiozita Polimiozita Poliartrita reumatoida + (30%) ± +++ + ++ +++ (75%) ± ++ ++ ++ (60%) ++ + (20%) +++ ± +++ ± + .

Afectarea pulmonara in vasculite = inflamatia si lezarea vaselor cu sindroame clinice heterogene Vasculita primara (singura manifestare a bolii) secundara unei alte boli ( infectie.mai multe organe / sisteme . neoplasm. pielea) . boli reumatice) Afecteaza .un singur organ (de ex.

Afectarea pulmonara in vasculite Vasculite granulomatoase (fenomen imun mediat celular Ac ANCA) Granulomatoza Wegener Sd. DM Purpura Henoch-Schonlein Arterita temporala + Limfocite Arterita Takayasu T . Churg Strauss Vasculite leucocitoclastice (complexe imune) LES. SS. PR.

artralgii. ulceratiile orale si genitale . vezicule Iridociclita.Vasculite ± manifestari clinice Semne generale febra. eruptii purpurice. stare generala. epistaxis. astm bronsic Manifestari sistemice Ulcere cutanate. sinuzita. tusea. leziuni cutanate Pulmonar Dispneea.

Ig. ac. C´seric.Afectarea pulmonara in vasculite VSH. ANCA Rx ‡ Infiltrate difuze ‡ Revarsate pulmonare ‡ Noduli pulmonari Diagnostic + Biopsia cutanata Biopsie transbronsica toracotomia exploratorie CT Arteriografie Gazometria sanguina ± hipoxemie cu alcaloza respiratorie . FR.

dispnee.pulmonar . puroi.infiltrate nodulare (± tuse.Granulomatoza Wegener = vasculita granulomatoasa ± tract respirator inalt (sinusuri si nazo-faringe) (durere. ulceratii) . hemoptizie) + glomerulonefrita .

Granulomatoza Wegener ‡ pANCA ‡ Biopsie ± granulom necrozant .

Sindromul Churg-Strauss = vasculita alergica si granulomatoasa Astma + Eozinofilie + Granuloame extravasculare + Vasculita .