semne in imagistica toracica ct
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Computer tomografieComputer tomografie
Medic rezident:Bica Mihaela Felicia
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DefDef= arie de atenuare de tip ,,sticla mata’’ in jurul unui nodul sau mase pulmonare
TipicTipic : in stadiile precoce de aspergilom invaziv la pacientii imunocompromisi
Alte entitati : Pneumonie eozinofilica Bronsiolita obliteranta organizata pneumonic Granulomatoza Wegener , Carcinom bronhoalveolar, limfom , MTS
Formare :- variaza in functie de boala - in aspergilom si cancerul bronhoalveolar
semnul este dat de hemoragia alveolara
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Figura 1. a, b. CT semnul haloului (sageti). a. aspergilom invaziv la un pacient cu leucemie acuta:
a
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Def= arie de atenuare de tip ,,sticla mata’’ focala, rotunda inconjurata de o consolidare in forma de semiluna sau cerc (semnul Attol)
Etiologie: - specific pentru pneumonie criptogenica organizata- Granulomatoza limfoida- Sarcoidoza- Infectii fungice
Aria de atenuare centrala de tip ,,sticla mata’’ ◦ corespunde histopatologic unei arii de inflamatie septala
alveolara si resturi celulare Aria de consolidare in forma de cerc
◦ corespunde unei arii de organizare pneumonica in ductele alveolare
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Fig. 10 Semnul haloului inversat . a,b. Pacient cu infectie pulmonara fungica invaziva
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Def= hiperdensitati ale tesutului moale cu aspect de ramificatii tubulare sau in deget de manusa in forme de V sau Y
Formare : este dat de bronhiile dilatate umplute cu mucus (impactul mucoid)
Entitati: -orice leziune obstructiva poate duce la bronsiectazie si impact mucoid
- tumori maligne si benigne, atrezie congenitala bronsica, bronholitiaza, strictura TBC, sechestrare intralobulara, chist bronhogenic intrapulmonar, aspiratie de corp strain
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Entitati in care apare semnul degetului de manusa in absenta obstructiei :
Astmul ( datorita hipersensibilitatii cailor aeriene si productiei de mucus)
Aspegilomul bronhopulmonar alergic (hipersensibilitatea cailor aeriene, productia de mucus, proliferarea saprofitica a microorganismelor in interiorul bronhiei dilatate )
Chistul fibros (impactul mucoid este dat de afectarea actiuni ciliare si secretia groasa anormala)
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Figura 2. a–c. Semnul degetului de manusa. a. bronhii umplute cu mucus la un pacient cu cancer pulmonar b. bronhii umplute cu mucus la un pacient cu astm cr.
aa ba b
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In mod normal diametrul bronhiei este egal cu diametrul arterei adiacente ( raportul bronhoarterial=1 )
Semnul inelului cu pecete apare in momentul in care raportul bronhoarterial creste
Acest semn poate fi vazut oriunde in plaman Entitati : bronsiectazii Ajuta la diferentierea bronsiectaziei de o alta leziune
chistica a plamanului Alte semne insotitoare cum ar fi ingrosarea
peribronsica, lipsa de ingustare bronsica si vizualizarea bronhiilor la un 1cm de pleura contribuie la diagnostic
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Fig. 3 Semnul inelului cu pecete. Pacient cu bronsiectazie
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Def= hiperdensitate curbiliniara ce se intinde de la o masa subpleurala spre hil
Formare: apare ca urmare a unei atelectazii rotunde ce determina distorsiuni bronhovasculare
Se poate constata de asemenea ingrosare pleurala si diminuarea de volum a plamanului afectat
Exista 2 ipoteze de formare a atelectaziei rotunde : o efuziune pleura subiacenta ce cauzeaza o atelectazie locala in plamanul adiacent sau pleurita locala cauza de substante iritante cum ar fi azbestul, tbc, pleurita nespecifica
Uneori atelectazia rotunda este dificil de diferentiat de un cancer pulmonar periferic si atunci se recomanda biopsie
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Fig. 4 Semnul cozii de cometa; a.Pacient cu istoric de pleurita tbc; atelectazie subpleurala (sageata) si structuri bronhovasculare cu extindere spre hil (restul sagaetilor); b. pacient cu azbestoza,
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Def= vizualizarea calibrului crescut si contrastarii intense a vaselor pulmonare intr-o condensare pulmonara vizualizata in ,,fereastra de mediastin’’
Etiologii: cancer bronhoalveolar limfom pneumonie infectioasa si postobstructiva edem pulmonar mts date de cancere gastrointestinale
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Fig. 5 semnul angiogramei CT; pacient cu cancer bronhoalveolar (contrastarea vasculara intr-o masa tumorala)
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Def=atenuare difuza sau dispersata de tip ,,sticla mata’’ cu suprapunerea de septuri interlobulare ingrosate si linii intralobulare
Etiologie : ◦ proteinoza pulmonara alveolara (atenuarea de tip ,,sticla
mata’’ este data de materialul intraalveolar hipodens reprezentat de glicoproteine iar atenuare de tip reticular suprapusa este data de infiltratul interstitial al celulelor inflamatorii)
◦ Pneumonia cu Pneumocystis carinii◦ Carcinomul bronhoalveolar mucinos, Sarcoidoza◦ Pneumonia interstitiala nonspecifica◦ Pneumonia lipoida exogena◦ Pneumonia organizata criptoida◦ Sindromul de detresa respiratorie acuta ◦ sindromul pulmonar hemoragic
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Fig. 6 Semnul crazy paving.a.Pacient cu situs inversus si
proteinoza alveolarab.Pacient cu proteinoza alveolarac.Pacient cu pneumonie cu
Pneumocystis carinii
ab
cc
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Def= se caracterizeaza prin mici nodului centrolobulari conectati la multiple ramificatii liniare (bronhiole impactate mucoid)
Acest semn ajuta la identificarea afectarii cailor aeriene mici.
Etiologie: - raspandire endobronsica cu Mycobacterium tuberculosis- afectarea periferica a cailor aeriene:infectii ( virale,
bacteriene, fungice, parazitare) ; congenitale; idiopatice (bronsiolita obliteranta, panbronsiolita, aspiratie sau inhalare de corpi straini), afectare imunologica, tulburari de tesut conjunctiv si boli vasculare (microembolisme)
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Fig. 7 Semnul arborelui inmugurit. Pacient cu tuberculoza: multipli noduli centrilobulari
conectati la multiple structuri ramificate liniare
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Def= se caracterizeaza prin prezenta unui vas distinct care merge direct spre un nodul sau o masa
Este un semn inalt sugestiv pentru embolismul septic si destul de frecvent in metastazele pulmonare si fistula arteriovenoasa. Este mai rar intalnit in cancerul pulmonar si tuberculom.
Fig. 8 pacient cu cancerbronsic
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Def= ingrosarea si separarea foitelor pleurale de fluid si priza de contrast a acestora
Este un semn tipic pentru empiem pleural si ajuta la diferentirea de abces pulmonar.Este frecvent intalnita si in hemotorax si pleurodeza cu talc;
Fig. 9 a. empiem, b. abces pulmonar
ab
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Def= spatii chistice aeriene, grupate intre 0,3-1cm diametru situate bazal subpleural;
peretii chisturilor sunt peretii bronhiilor dilatate si ingrosate;
este o afectare ireversibila Etiologie: in fibroza pulmonara
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Fibroza chistica◦ Multiple imagini chistice ,grupate◦ Situate pe toata aria pulmonara in special bazal◦ Cu pereti ingrosati◦ Absenta vizualizari de parenchim normal intre chisturi◦ Scadere diametrului in expir si cresterea in inspir a formatiunilor chistice
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Emfizem panlobular si bulos◦ Fara modificarea calibrului postexpir
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Plaman chistic in histocitoza Langerhans ◦ parenchimul dintre
chisturi de aspect normal◦ peretii chisturilor subtiri ◦ localizare pefiferica
redusa
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Emfizem centrilobular◦ Formatiuni de densitate aerica , rotunde◦ De dimensiuni mult mai mici decat chisturile◦ Cu parenchim normal intre leziuni◦ Fara pereti vizibili
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Fig . 11 Copil de 15 ani cu fibroza chistica
Rx: fibroza , infiltrate si imgini hiroaerice date de bronhiile marite de tip chistic
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Apare in bronsiectaziile chistice Acest semn apare tipic in situatia cand bronsiectaziile de tip
sacciform apar intr-un sindrom de condensare retractil
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Intalnit in bronsiectaziile moliniforme
Apare ca urmare a alternantei dintre dilataii si zonele ingustate
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Hiperdensitati liniare paralele date de ingrosarea peretilor bronsici
Intalnita in bronsiectaziile cilindrice
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Def= arie de atenuare crescuta, neclara, la nivelul plamanului, extinsa, fara afectarea conturului bronhovascular
Cauzata de : expiratie normala, umplerea partiala a spatiilor aeriene, colaps alveolar partial, ingrosare interstitiala, inflamatie, edem, fibroza
Etiologi:◦ Procese infectioase (pneumonia cu
pneumocistis, citomegalovirus , virusul herpetic , bronsiolita cu virusul sincitial respirator)
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◦Boli cronice interstitiale (pneumonia eozinofilica, pneumonia interstiala idiopatica, sarcoidoza)
◦Boli alveolare acute: (edem pulmonar acut cardiogenic si non-cardiogenic , sindr. de detresa respiratorie acuta)
◦Alte cauze : carcinom bronhoalveolar ; rare: fibroza interstiala idiopatica, aspergiloza, Wegener granulomatosis
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1.Pacienta HIV pozitiva cu pneumonie cu pneumocystis 2. CT toracic: plaman aspect normal