DIAGNOSTICO POR

IMAGENES
Dra Patricia Coral Gonzales
Curso: Medicina 1
PATRICIA CORAL GONZALES
Medico Cirujano Especialista en Radiología
Maestría en Investigación Clínica
Medico Asistente del Dpto de Diagnostico por Imágenes
IREN Norte.
Caso 1
Caso 2
Cuadro clínico
?
.
.
.
.
INFORMACION CLINICA

CASO1: Paciente varón de 48 años, que presenta desde hace 5 días,

alza térmica intermitente. Niega Tos y dificultad para respirar.Niega
antecedentes.
CASO 2: Paciente mujer 58 años, que presenta tos no productiva, alza
termica esporadica, dificultad respiratoria. Ant BDT.
Problemas diagnósticos

.
.
.
DIAGNOSTICO
CASO1: NEUMONIA VIRAL POR SARS COV2. GRADO DE SEVERIDAD LEVE
CASO 2: SDRA POR SARS COV2.
NEUMONIAS VIRALES

Mas allá de la consolidación.

INTERSTICIO PULMONAR

Veronica Lorenzo Quesada FEA H.U.P.R

PATRON INTERSTICIAL
• PATRON LINEAL-RETICULAR
• PATRON NODULAR
• PATRON EN VIDRIO
DESPUSTRADO
• PATRON QUISTICO
• PATRON CONDENSACION O
CONSOLIDACION.

Veronica Lorenzo Quesada FEA H.U.P.R

 PATRONES INTERSTICIALES

Patrones radiológicos en la enfermedad pulmonar intersticial Ana Giménez Palleiro∗ y Tomás Franquet
 PATRONES INTERSTICIALES

Patrones radiológicos en la enfermedad pulmonar intersticial Ana Giménez Palleiro∗ y Tomás Franquet
 Figure 1a. Schemas show typical CT patterns of viral pneumonia. (a) Pneumonia due to varicella-zoster virus shows multifocal 1–10-mm well-defined or ill-defined nodular opacity (arrows) with a
surrounding halo or patchy GGO (arrowheads) in both lungs.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
PATRON RADIOLOGICO
NEUMONIA VIRAL
VIDRIO DESLUSTRADO GGO (ground glass opacity)
ENGROSAMIENTO SEPTAL
PSEUDONODULOS SUBSOLIDOS
 Figure 1b. Schemas show typical CT patterns of viral pneumonia. Pneumonia due to CMV shows diffuse ill-defined patchy GGO with interlobular septal thickening (arrowheads) in both lungs.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 1c. Schemas show typical CT patterns of viral pneumonia. (c) Pneumonia due to HMPV shows multiple ill-defined nodules (arrows) or GGO (arrowhead) along the bronchovascular bundles in both
lungs. These findings are similar to those of HPIV pneumonia, which belongs to the same viridae.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 1d. Schemas show typical CT patterns of viral pneumonia. (d) Pneumonia due to influenza A virus shows multiple irregular areas of consolidation (arrows) along the bronchovascular bundles and
diffuse GGO (arrowheads) with interlobular septal thickening in both lungs.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 1e. Schemas show typical CT patterns of viral pneumonia. (e) Pneumonia due to rhinovirus shows multiple ill-defined patchy areas of GGO (arrows) with interlobular septal thickening (arrowheads)
in both lungs.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 2a. Pneumonia due to adenovirus in a 20-year-old man with fever, cough, and dyspnea. (a) Initial chest radiograph shows ill-defined patchy consolidation and GGO (arrows) in the left middle to
lower lungs and the right lower lung zone.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 2b. Pneumonia due to adenovirus in a 20-year-old man with fever, cough, and dyspnea. (b, c) Axial chest CT images (5-mm thickness) obtained on the same day at the interlobar bronchi level (b)
and the inferior pulmonary vein level

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 3a. Pneumonia due to HSV in a 72-year-old woman with multiple myeloma. (a) Initial chest radiograph shows ill-defined diffuse reticular areas of increased opacity (arrows) in both lungs. (b, c)
Axial thin-section (1-mm collimation) CT images at the carina (b) and the left inferior pulmonary vein level (c) show diffuse interstitial and interlobular septal thickening (arrowheads) with patchy GGO
(arrows) in both lungs. A small amount of bilateral pleural effusion (*) is noted.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 3b. Pneumonia due to HSV in a 72-year-old woman with multiple myeloma. (a) Initial chest radiograph shows ill-defined diffuse reticular areas of increased opacity (arrows) in both lungs. (b, c)
Axial thin-section (1-mm collimation) CT images at the carina (b) and the left inferior pulmonary vein level.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 4a. Pneumonia due to varicella-zoster virus (α Herpesvirinae) in a 53-year-old man who underwent liver transplantation 5 months before contracting the disease. (a) Initial chest radiograph shows
multifocal reticulonodular infiltrations (arrows) in both lungs. (b, c) Thin-section (1-mm collimation) axial CT image (b) and coronal reconstructed CT image (5-mm thickness)

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 4b. Pneumonia due to varicella-zoster virus (α Herpesvirinae) in a 53-year-old man who underwent liver transplantation 5 months before contracting the disease. (a) Initial chest radiograph shows
multifocal reticulonodular infiltrations (arrows) in both lungs. (b, c) Thin-section (1-mm collimation) axial CT image (b) and coronal reconstructed CT image (5-mm thickness)

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 5a. Pneumonia due to CMV in a 28-year-old man with graft-versus-host disease after bone marrow transplantation for chronic myeloblastic leukemia. (a) Initial chest radiograph shows diffuse ill-
defined GGO (arrows) in both lungs. (b, c) Axial thin-section (1-mm collimation) CT images obtained on the same day, at the lower trachea level (b) and interlobar area level (c), show ill-defined GGO
nodules, interlobular septal thickening (arrowheads), and diffuse GGO (arrows) in both lungs, with a scanty amount of bilateral pleural effusion (* in c).

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 5b. Pneumonia due to CMV in a 28-year-old man with graft-versus-host disease after bone marrow transplantation for chronic myeloblastic leukemia. (a) Initial chest radiograph shows diffuse ill-
defined GGO (arrows) in both lungs. (b, c) Axial thin-section (1-mm collimation) CT images obtained on the same day, at the lower trachea level (b) and interlobar area level (c), show ill-defined GGO
nodules, interlobular septal thickening (arrowheads), and diffuse GGO (arrows) in both lungs, with a scanty amount of bilateral pleural effusion (* in c).

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 11a. Pneumonia due to influenza A virus in a 38-year-old pregnant woman at the gestational age of 29 weeks and 5 days who presented with a cough and dyspnea. (a) Initial chest radiograph
shows extensive patchy consolidation (arrows) with air bronchogram (arrowheads) in both lungs, especially in the middle to lower lung zones. After the patient underwent an emergency cesarean delivery,
intubation and extracorporeal membrane oxygenation were performed for acute respiratory distress syndrome.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 11c. Pneumonia due to influenza A virus in a 38-year-old pregnant woman at the gestational age of 29 weeks and 5 days who presented with a cough and dyspnea. (a) Initial chest radiograph
shows extensive patchy consolidation (arrows) with air bronchogram (arrowheads) in both lungs, especially in the middle to lower lung zones. After the patient underwent an emergency cesarean delivery,
intubation and extracorporeal membrane oxygenation were performed for acute respiratory distress syndrome. (b) Chest radiograph obtained 3 weeks later shows decreased intensity of irregular
consolidation (arrows). (c) Axial CT image obtained on the same day as b shows irregular consolidation (arrows) along the bronchovascular bundles and diffuse GGO with interlobular septal thickening
(arrowheads) in both lungs. The patient underwent reverse-transcription polymerase chain reaction for viral infection with sputum and blood culture and bronchoalveolar lavage to find superimposed
infection. However, there was no evidence of coinfection.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 12a. Pneumonia due to MERS coronavirus in a 27-year-old man who presented with a cough and sputum. (a) Initial chest radiograph shows increased areas of ill-defined nodular opacity (arrows)
in both lower lung zones, especially in the left retrocardiac area. (b–d) Axial CT images (3-mm section thickness) obtained on the same day at the level of the right inferior pulmonary vein (b) and the
junction of the right atrium and inferior vena cava (c) and a coronal reconstruction image at the vertebral body level (d) show multifocal patchy and nodular consolidation with GGO (arrows) in both lower
lobes.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 12b. Pneumonia due to MERS coronavirus in a 27-year-old man who presented with a cough and sputum. (a) Initial chest radiograph shows increased areas of ill-defined nodular opacity (arrows)
in both lower lung zones, especially in the left retrocardiac area. (b–d) Axial CT images (3-mm section thickness) obtained on the same day at the level of the right inferior pulmonary vein (b) and the
junction of the right atrium and inferior vena cava (c) and a coronal reconstruction image at the vertebral body level (d) show multifocal patchy and nodular consolidation with GGO (arrows) in both lower
lobes.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 12d. Pneumonia due to MERS coronavirus in a 27-year-old man who presented with a cough and sputum. (a) Initial chest radiograph shows increased areas of ill-defined nodular opacity (arrows)
in both lower lung zones, especially in the left retrocardiac area. (b–d) Axial CT images (3-mm section thickness) obtained on the same day at the level of the right inferior pulmonary vein (b) and the
junction of the right atrium and inferior vena cava (c) and a coronal reconstruction image at the vertebral body level (d) show multifocal patchy and nodular consolidation with GGO (arrows) in both lower
lobes.

Koo HJ. Published Online: May 14, 2018

https://doi.org/10.1148/rg.2018170048
 Figure 1: A 65-year-old female patient who had travelled to Wuhan, China, subsequently developing fever and cough 5 days after arrival. She subsequently returned to Shenzhen, China, and had this
chest CT 7 days after symptom onset. Coronal and axial CT images (A & B) showing a mixture of ground glass and consolidation in the periphery of the lungs (red arrows), with absence of pleural
effusions, which was the typical appearance of patients with confirmed COVID-19 infection.

Ng M. Published Online: February 13, 2020

https://doi.org/10.1148/ryct.2020200034
NEUMONIA POR SARS COV 2
 Figure 2: Comparison of chest radiograph (image A) and CT thorax coronal image (image B). The ground glass opacities in the right lower lobe periphery on the CT (red arrows) are not visible on the
chest radiograph, which was taken 1 hour apart from the first study.

Ng M. Published Online: February 13, 2020

https://doi.org/10.1148/ryct.2020200034
Caso 2

La radiología en el diagnóstico de la neumonía por SARS-CoV-2 (COVID-19). Med Clin (Barc). 2020.
https://doi.org/10.1016/j.medcli.2020.03.004
INFECCION SARSCOV2
• La infección COVID-19 puede presentarse como una enfermedad leve,
moderada o grave, incluyendo neumonía severa, síndrome de
dificultad respiratoria aguda (SDRA), sepsis y shock séptico.
• El período de incubación: 5 días (intervalo: 4-7 días) con un máximo
de 12-13 días.
• La enfermedad leve puede manifestar síntomas similares a la gripe:
fiebre alta, mialgias, fatiga y síntomas respiratorios, especialmente tos
seca, con posible evolución a neumonía. El comienzo suele ser menos
brusco que en la gripe y los síntomas de vías respiratorias superiores
parecen poco importantes o están ausentes.
INFECCION SARSCOV2
• Fuente de infección: pacientes infectados por SARS-CoV-2. Mayor incidencia en varones, debido a influencia
del cromosoma X y las hormonas sexuales en la inmunidad innata y adaptativa.
• Transmisión: gotas respiratorias (aerosoles > 5 μm) en distancias cortas (1,5-2 m) cuando los pacientes tosen,
hablan o estornudan, y mediante contacto próximo con boca, nariz o conjuntiva ocular a través de manos
contaminadas. El contacto prolongado es el de mayor riesgo, siendo menos probable el contagio a partir de
contactos casuales. Pueden existir contagios a partir de pacientes asintomáticos e incluso a partir de
personas en período de incubación de la enfermedad. Es probable una transmisión por superficies
infectadas, habiéndose descrito recientemente que el SARS-CoV-2 puede persistir en plásticos y acero
inoxidable hasta 72 h.
• Diagnóstico: Reacción en cadena de la polimerasa con transcriptasa inversa (reverse transcription polymerase
chain reaction [RT-PCR]) con la detección de ácidos nucleicos del SARS-CoV-2 o mediante la secuenciación del
gen viral. Se pueden emplear muestras de frotis faríngeo o nasofaríngeo, esputo, heces o sangre.
• El cribado por RT-PCR se considera la prueba de laboratorio de referencia para el diagnóstico de COVID-19.
En algunos casos se han documentado falsos negativos, que probablemente se produzcan por material viral
inadecuado en la muestra o por problemas técnicos durante la extracción de ácido nucleico.
HALLAZGOS RADIOLOGICOS
• Afectación en vidrio deslustrado, aislada o en combinación con
consolidaciones pulmonares (GGO).
• Otros hallazgos son el engrosamiento de septos interlobulillares,
bronquiectasias, engrosamiento pleural, el patrón en empedrado, el
predominio de la afectación bilateral de lóbulos inferiores y la
localización periférica y posterior .

La radiología en el diagnóstico de la neumonía por SARS-CoV-2 (COVID-19). ELSEVIER

 Figure 6: Axial CT images showing a case of COVID-19 (image A) and a case of severe acute respiratory syndrome (SARS) from 2003 (image B). Both cases demonstrate similar predominantly ground-
glass opacities affecting both lungs.

Ng M. Published Online: February 13, 2020

https://doi.org/10.1148/ryct.2020200034
Song F. Published Online: February 06, 2020
https://doi.org/10.1148/radiol.2020200274
INTRODUCCION AL
DIAGNOSTICO POR
IMAGENES
PREVENCION

MAMOGRAFIA
TC TORAX BAJA DOSIS
PREVENCION
• Objetivo:
El reconocimiento de manifestaciones tempranas del cáncer y
pequeños tumores clínicamente indetectables.
Mamografía: Ha ayudado ha reducir un 30% la mortalidad de cáncer
de mama.
Tomografía Multidetector:
- TCMD baja dosis, redujo en 20% la mortalidad de cáncer de pulmón
en fumadores.
- Detecta lesiones premalignas en colon.
Mujer de 44 años. Asintomatica
Mujer de 40 años, nulípara, asintomática.
Mujer 42años, con ant. Familiares de Cancer
de mama.
SCREENING CANCER DE PULMON
• Factores de Riesgo:
- Fumadores
DETECCION

RADIOGRAFIA, MAMOGRAFIA, ECOGRAFIA, TOMOGRAFIA, RESONANCIA

MAGNETICA, GAMAGRAFIA.
ENFERMEDADES INFECCIOSAS: TBC
Infecciones virales
CANCER PULMONAR
ECOGRAFIA
Varon de 35años, con Cefalea, convulsiones.
RM
Mujer posmenopáusica con sangrado vaginal.
Ca Endometrio
METASTASIS OSEA: GAMAGRAFIA
SEGUIMIENTO
Mujer de 45 años con antecedente quirúrgico
reciente de mastectomía izquierda. La imagen de
TC con contraste intravenoso muestra una
colección hipodensa biloculada en la mama izq,
correspondiente a un seroma.

COMPLICACIONES QUIRURGICAS
NM mama izq pos tumorectomia, 18 meses después.

METASTASIS PULMONAR
RE ESTADIAJE
TRATAMIENTO

PROCEDIMIENTOS INTERVENCIONISTAS DIAGNOSTICOS Y TERAPEUTICOS

Mamografia,microcalcificaciones. Arponaje
Biopsia percutánea, core biopsia.
DRENAJE BILIAR percutaneo

Haga
Haga clic
clic en
en el
el icono
icono para
para Haga
Haga clic
clic en
en el
el icono
icono para
para
agregar
agregar una
una imagen
imagen agregar
agregar una
una imagen
imagen
QUIMIOEMBOLIZACION: Tumor hepático.
IMÁGENES FUNCIONALES NO
INVASIVAS

DWI-MR, Contraste dinamico por RM, CT PERFUSION, PET TC/RM

Otras técnicas por ecografía: Elastografia, ecografía contrastada.
Paciente con cáncer de laringe con múltiples
conglomerados adenopáticos laterocervicales.
El de mayor tamaño (flecha), presenta áreas
hipocaptantes en su interior sugerentes de
necrosis y marcada restricción de la difusión
compatible con afectación metastásica.
Paciente con linfoma Hodgkin.
PET-CT : Afectación mediastínica, hiliar y axilar con adenopatías
con metabolismo aumentado.
No se objetivó afectación por debajo del diafragma.
RM PERFUSION: El mapa de perfusion relacionado con la celularidad refleja la
probabilidad de cáncer en la glándula prostática central.
EL RADIÓLOGO OCUPA EL
CENTRO DE ATENCIÓN

Hacer visible el la enfermedad….

GRACIAS POR SU
ATENCION