torace-mediastin an v studenti
TRANSCRIPT
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Torace normal si tehnici de examinare a toracelui
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Radiografie:
- opac=alb
- transparent= negru
Radioscopie:
- opac= negru
- transparent= alb
Fosforescenta Fluorescenta
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Cum se face o radiografie toracica?:
- ortostatism
- pozitie frontala- incidenta PA
- in apnee, dupa un inspir profund
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Radiografia toracică de profil
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E corect facuta? Dupa ce ma uit:
1. Adnotatii
2. Regim (mA, kV)
3. Simetrie
4. Degajarea omoplatilor
5. Momentul respiratiei:
- Daca e apnee contur net cupole diaf
- Daca e inspir arcuri costale anterioare 6-7 X diaf sau 8-9 arcuri posterioare
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PA usor rotit
Sistematizarea interpretarii:
1. Continator:
- cutia toracica ansamblu
- Oase
- Parile moi
- diafragm
2. Continut:
- Plaman
- Cord
- Vase
- Trahee
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12
3
4
5
Numararea coastelor
Aprecierea simetriei
Sinusuri: CD, CF
Diafragmul drept mai sus situat cu 1.5cm decat diafragmul stg.
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Scizura oblica: de la T3 pana la marginea anterioara a diaf
Scizura orizontala: de la ½ scizura oblica spre anterior
Cum stim pe profil care e
diafragmul drept si stang?
LS
LI
LM
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LOBII PULMONARI
LSD
LM
LID
Profil D Profil GFace
LIG
LSGPS
GSGS
H H H
AV G AV
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Hilii pulmonari: artere pulmonare in principal si intr-o mica masura de venele pulmonare
Desenul pulmonar: artere
Hil drept mai jos situat cu 1.5cm
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Mantaua lui Felix
1.5-2cm in periferia campului pulmonar nu vedem desen vascular in mod normal
Fiziologic baza mai perfuzata si varful mai ventilat
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Computer tomografia toracica
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Tehnica explorării CT1. poziţia bolnavului: decubit dorsal cu braţele deasupra capului, in apnee, dupa inspir profund2. obtinerea imaginii SCOUT- topograma toracica
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Examinarea sectiunilor implica 3 timpi cu 3 ferestre densitometrice:- fereastra mediastinala- fereastra de plaman- fereastra osoasa
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Semiologie radiologica toraco-pleuro-pulmonara
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1. Modificarile cutiei toracice • Modificari statice
Globale• Dimensiune: < sau >• Forma: constitutional normal: stenic, astenic, picnic
patologic: cifotic, cifo-scoliotic, astenico-astmatic, carena
Partiale • Scheletice: coasta cervicala, hipoplazie costala, bifiditate, fracturi,
calusuri, tumori• Diafragm: inalt, aplatizat, feston• Mediastin: largit, deplasat (aderente, aspiratie, compresiuni)
• Modificari dinamice Diafragm cu mobilitate redusa: aderente masive, procese supra \
subdiafragmatice Miscare in balama: simfiza Miscare in balanta: paralizie de frenic Pendulare mediastnala Holznecht-Jakobsohn: stenoze bronsice
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Opacitati pulmonare
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• Sediu: lobi, segmente, scizurisemnele radiologice
• Numar: – unice: pneumopatii, tu benigne, maligne– multiple (diseminare bronhogena sau hematogena): br-
pn, metastaze, TBC miliara
• Forma:– rotunda: chist hidatic, tumori, tuberculom– nodulara: pneumoconioze, br-pn, meta– segmentara: pneumopatii, atelectazii– liniara (interstitiu, pleura, scizuri)– reticulara (interstitiu difuz)– policiclica: adenopatii hilare– stelata: cicatrici
• Dimensiuni
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• Contur:– net si liniar: foita pleurala sau nivel hidroaeric– net: chist hidatic– difuz: congestie pulmonara– invadant: cancer exobronsic
• Structura: omogena \ inomogena
• Intensitate: medie \ mare \ mica
• Raporturi:– tractiune: aderente– aspiratie: atelectazie– impingere: bula de emfizem, tumora– modificarea volumelor toracic si pulmonar
• Functionalitate:– pulsatii, Valsalva, Muller
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Transparente
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• Circumscrise: dimensiuni variate, precis delimitate– congenitale: bule de emfizem, chiste aerice, plaman
polichistic
– ulcerativ \ necrotic: caverna TBC, abces pulmonar total evacuat
– ventil de tip expirator: bule de emfizem, pneumatocel posttraumatic
• Difuze: dimensiuni relativ mari, contur imprecis– fara desen pulmonar: pneumotorace, chiste aeriene
gigante
– cu desen pulmonar: astm bronsic in criza, emfizem pulmonar, hipovascularizatie pulmonara
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Imagini mixte pulmonare
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• Sistematizate: tipic imagine de nivel hidro-aeric– abces pulmonar partial evacuat– chist aerian suprainfectat– chist hidatic partial evacuat– hidropneumotorace
• Nesistematizate:– nu se pot incadra in formele sistematizate:
metastaze pulmonare, leziuni tuberculoase extinse, fibrotorace mutilant
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Sindroame radiologice pulmonare
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Sdr de umplere alveolara: cu ce se pot umple alveolele?
• Exudat pn franca lobara
• Transudat EPA
• Sange infarct pulmonar, contuzie
• Celule NODULI (p, m, n)
- p sub 1.5mm
- m intre 1.5 si 3mm
- n peste 3mm
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Sindrom de umplere alveolara: Pneumonia clasica
• opacitate net delimitata de scizura, flu delimitata inspre parenchim• confluere rapida a opacitatilor (!BP)• evolutie cu crestere rapida a opacitatii• volumul alveolelor umplute nemodificat • prezinta bronhograma si alveolograma
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Sindrom bronsic: ATELECTAZIE
• Semne directe: opacitate omogena, sistematizata, fara bronhograma aerica, bine delimitata, margini concave, dimensiuni mai mici decat ale regiunii normale
• Semne indirecte: deplasarea oganelor mediastinale catre opacitate, ridicarea cupolei hemidiafragmului, atragerea hilului, hiperinflatie de vecinatate, micsorarea spatiilor intercostale
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Sindrom interstitial:
• topografie difuza• fara sistematizare• contur net• densitate slaba• lipsa tendintei la confluere• evolutie lenta
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Sindrom pleural:
• opacitate bazala care urca laterotoracic• delimitare neta• concavitate care priveste cranial si medial• deplasarea mediastinului de partea opusa in functie de cantitatea de lichid
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TOPOGRAFIA MEDIASTINULUI ÎN LL
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COMPARTIMENTAREA MEDIASTINALA
m. anterior:
1, 2, 3
m. mijlociu: 4,5,6
m. posterior:
7
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Ce gasim in mediastin in functie de compartimente si etaje?
Compartimentul anterior: intre stern si linia paratraheala anterioara:
1. etaj superior: timus, tiroida, paratiroide, trunchiuri vasculare arteriale si venoase
2. etaj mijlociu: timus, Ao ascendenta, APu, teratoame, chist dermoid, chistepidermoid
3. etaj inferior: cord, pericard, pleura CHISTE PLEUROPERICARDICE
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Compartimentul mijlociu: intre cele 2 linii paratraheale (ant si post)
• ADENOPATII MEDIASTINALE!!
• TRAHEE, BR PRINCIP (chiste bronhogenice)
• VASELE MARI
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Compartiment posterior: coloana, esofag, lt ggl paravertebrale
1. Etaj superior si mijlociu = tu nervoase paravertebrale
2. Chiste paraesofagiene, hernie hiatala
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Tumori disembrioplazice-patologie proprie a mediastinului
• Homoplastice:- Formate din tesutut/uri care se gasesc in mod normal in
mediastin- Chistele pleuro-pericardice (MAI)- Chistele bronhogenice (MM, MAI)• Heteroplastice: MAM- Formate din testuri care nu se gasesc in mod normal in
mediastin- Chistele epi/dermoide- Teratoame - Semnul Phemister : tu cu nivel solid-solid