LP 2-2RADIO.pptx
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Transcript of LP 2-2RADIO.pptx
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PATOLOGIA INFECTIOASA A
APARATULUI RESPIRATOR
DR. SPIRIDON ELENA
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Etiologie: bacterii, virusuri, fungi
Clasifcare: Pneumonii bacteriene nesupurate: Pneumonia lobara franca Bronhopneumonia
Pneumonii bacteriene supurate: Abcesul pulmonar
Gangrena pulmonara Supuratii pulmonare difuze
Pneumonii interstitiale
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Pneuonia !acteriana"#ranca lo!ara$
Etiologie: Streptococcus pneumoniae (90!
As%ect ra&iologic: sindrom de umplere alveolara
evolutie in concordanta cu stadiile anatomo"patologice
De!ut: #$h % faza de congestie alveolara si e&udatie
aspect normal'direct aspectul din faza de stare
Perioa&a &e stare: #" zile % alveolele ocupate de e&udat sero)brinos cu numeroase leucocite
*pacitate triunghilara, cu varful la hil si baza la periferie, fara modi)careadimensiunii teritoriului pulmonar respectiv, limita spre scizura neta si sprecelelalte segmente imprecisa, intensitatate medie, omogena, cubronhograma aerica prezenta
Perioa&a &e resor!tie
+"9 zile de la debut'#"-h de la initierea antibioterapiei .ntensitatea opacitatii incepe sa scada, apare alveolograma aerica
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'o&alitati &e resor!tie:
omogena"scaderea intensitatii pe toatasuprafata/e la periferie spre centru ( )g1!/e la centru spre periferie ( )g/!
.n tabla de sah ()g2!
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Pneuonie L'D
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Pneuonie LSD
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Co%licatii: Abcesul pulmonar
Pleureziile para si metapneumonica
3ezolutia intarziata %varstnici, malnutritie,alcoolism
Pericardita purulenta % f rara
2ndocardita pneumococica % la bolnavi valvulari 4eningita pneumococica " rar, diseminare
hematogena
Glomerulonefrita pneumococica " mecanism
imunologic .nsu)cienta cardiaca acuta" varstnici
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Agenti etiologici: micoplasme, virusuri (respirator sincitial, gripal, paragripal,ru5eolei, varicelei!, ric6etsii
Anatoo(%atologic: in)ltrarea interstitiului peribronho"alveolar cu monocite,plasmocite, histiocite
As%ect ra&iologic:"desen pulmonar perihilar accentuat" uni sau bilateral" desen reticular )n, apoitrabecule opace groase, estompate
"opacitatile liniare formeaza un triunghi hilio"bazal care se desface in evantai ininspir profund (triunghiul gripal!
"opacitati miliare, micronodulare cu aspect bronho"pneumonic (plurifocale, cucontur imprecis!
"opacitatile nodulare se pot e&tinde la un segment
"aspect in sticla mata
E)olutie"7indecare fara sechele % imaginea radiologica dispare in - saptamani
"Pot persista noduli calci)cati % in varicela (calci)carea zonelor de necrozabronsiolara!
Co%licatii:
Pneuonia interstitiala
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.n)ltrat reticulo"nodular cu distributie bronho"vasculara bazal
drept (pneumonie cu adenovirus!
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*RON+OPNEU'ONIADEF: Pneumonia in focare multiple, care pot ) in stadii diferite de
evolutie
Agenti etiologici : sta)lococul, streptococul, 6lebsiela ,pneumococul
Afecteaza copii, batrani, persoane tarateContainare % inhalatorie' hematogena (septicemii!
As%ect ra&iologic: /2B" accent desen bronhovascular hilar si parahilar P23 /2 SA32 " noduli de diferite dimensiuni("0 mm!,de
intensitate medie, diseminati bilateral, asimetric, contur ;u (e&udatalveolar! si centru opac (bronsiola cu e&udat mucos, puroi!, tendinta
la con;uare " asincronism evolutiv (focarele bronsiolo"alveolare pot ) in faze de
evolutie diferite!
DD: uberculoza miliara (noduli diseminati uniform!, 4iliaracarcinomatoasa , 4etastaze pulmonare hematogene (contur net, nucon;ueaza!, Pneumonia lobara, .nfarct pulmonar
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Bronhopneumonia miliara
Multiple opacitati,
dimensiuni mici,
intensit. medie,
diseminati in
ambele arii
pulmonare,
predominant
parahilar si bazal.
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Bronhopneumonia macronodulara
Opacitati
nodulare,
localizate in
ambele ariipulmonare
(perihilar si
inferior), de
intensitate medie,
contur imprecis,
centru opac si cu
tendinta la
confluare.
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Bronhopneumonia forma pseudolobara
Opacitati
confluante
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Bronhopneumonia stafilococica
Sugari, copii.
Opacitati nodulare cu
tendinta la confluare, ce
evolueaza rapid spre
abcedaresi formare de
pneumatocele.
Caracteristica
variabilitatea imaginii
radiologice de la o zi la
alta.
Complicatii
piopneumotora!.
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AB12S< P
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Abcese multiplecomplicate
(post"vomica!localizate in focar
pneumonic
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Abces complicat
(post"vomica!recent" peretegros
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Abcese in diferitestadii evolutive:
necomplicate,post"vomica vechi
(nivel orizontal,
perete subtire!
C li tii b ltil l
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Co%licatii: " abces multilocular8
"gangrena pulmonara (focare de necroza septica, difuze, cu multipleimagini cavitare ce pot con;ua!
DD: 1> infectat, chist aerian infectat, 1BP supurat si abcedat,
caverna B, aspergiloza, chist bronhogen infectat
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C+ISTUL +IDATIC
aenia echinococcus"intestin embrion he&acant"sist port )cat"venele suprahepatice" cord dreapt"pl?m@n
C+ISTUL +IDATIC -NC+ISNECO'PLICAT opacitate ovalar/rotund
bine conturat?, contur tras cu compasul, aspect mai estompatdatorit? atelectaziei perichistice sau aspect n tre;?, n bisacdatorit? deform?rii din cauza obstacolelor anatomice
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1>necomplicat
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1> )surat
1> rupt
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>./A./*DA
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Diagnosticul &i#erential al iaginilor/i&roaerice
A. Iagini /i&ro(aerice %riare:
&. &magini hidro-aerice prin procese patologiceparenchimatoase,
cavern? B1 dup? eliminare parEial?8cancer pulmonar infectat si e&cavat8
chist hidatic pulmonar dup? vomic?8
atelectazie pulmonar? infectat? i e&cavat?
micoz? pulmonar? supra"infectat? i e&cavat?8
pl?m@n polichistic supra"infectat8
chist aerian infectat8
infarct pulmonar e&cavat8
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&&. &magini hidro-aerice prin procese patologice ronice,
broniectazii nespeci)ce infectate8
broniectazii speci)ce8
&&&. &magini hidro-aerice prin procese patologicepleurale,
;uido"pneumo"toracele (hidro'pio'hemo!
colecEii hidroaerice nchistate n scizuri i n mareacavitate8
&". &magini hidro-aerice prin procese patologicedigestive,
hernii hiatale8 hernia intratoracic? de colon8diverticul esofagian de pulsiune descins n mediastin8
megadolicoesofag
*.Iagini /i&ro(aerice secun&are :
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1-"F coarctatie ao ani
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Anevrism fuziform ao(arc! +cm vecin cu a sc stg
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1rohn disease Spot vie of theterminal ileum from a small"boel
follo"through studH demonstratesseveral narroing and stricturing,consistent ith the string sign Alsonote a sinus tract originating from themedial all of the terminal ileum andthe involvement of the medial all ofthe cecum
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1rohn disease Sonogram of athic6ened boel all demonstratesthe so"called pseudo6idneHappearance
1rohn disease 1obblestoning Spotvie of the terminal ileum from asmall"boel follo"through studHdemonstrates linear longitudinal andtransverse ulcerations that create acobblestone appearance Also notethe relativelH greater involvement ofthe mesenteric side of the terminalileum and the displacement of theinvolved loop aaH from the normalsmall boel secondarH to mesentericin;ammation and )brofattH
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Anevrism fuziform ao(arc! +cm vecin cu a sc stg
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1rohn disease Active small"boelin;ammation 1 scan demonstratessmall"boel all thic6ening,mesenteric in;ammatorH stranding,
and mesenteric adenopathH
1rohn disease 4esentericin;ammation 1 scan demonstratesan in;ammatorH mass in the rightloer Iuadrant associated iththic6ening of the all and narroingof the lumen of the terminal ileum
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43. enterographH -"dimensionalgradient postcontrast seriesdemonstrates strati)edhHperenhancement of the mucosa ofthe distal ileum in a patient ithactive 1rohn disease
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43. enterographH, steadH"state free"procession image, demonstratesvascular engorgement of the vasarecta or JcombJ sign in a thic6enedileum boel loop during activedisease
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43. enterographH ith coronal fat"saturated #"eighted single"shotfast spin echo imaging demonstratesmesenteric edema and mural alledema and thic6ening in a patient
ith active 1rohn disease in the distal
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.= P2322
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321 B AB12S 1*= C.S
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13*>= C.S
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C.S