Torace normal si tehnici de examinare a toracelui

PA

LL

PA usor rotit

Tintita

Cauze de erori

Pect

Mam

Semiologie radiologica toraco-pleuro-pulmonara

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

op

Modif statice globale

Modif statice

Torace cifoscoliotic

Ghibus

Calcif costale in banda, in plaja

Modif statice partiale

Calc tr-br

C Cervical

Sciyura v ayzgos

Abces subfrenic

Aerocolie stg

Relaxare dfgm

Semne radiologice

2. Aspectul leziunilor pleuropulmonare

Im in binoclu

S sil

S sil: 2 chiste alaturate

S Bernou

Bronhograma

Opacitati pulmonare

• Sediu: lobi, segmente, scizurisemnele radiologice

• Numar: – unice: pneumopatii, tu benigne, maligne– multiple (diseminare bronhogena sau hematogena): br-

pn, matastaze, TBC miliara

• Forma:– rotund: chist hidatic, tumori, tuberculom– nodular: pneumoconioze, br-pn– segmentar: pneumopatii, atelectazii– liniar (interstitiu, pleura, scizuri)– reticular (interstitiu difuz)– policiclic: adenopatii hilare– stelat: cicatrici

• Dimensiuni

• 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

Op multiple

Op unica

Op nodulara: TBC

Contur invadant

Contur net si liniar

Contur net

Chist hidatic

Contur difuz

Noduli interstit calcificati - silicoza

Op inomogena

Pleurezie

Calcif pleurale

Azbestoza

Transparente

• Circumscrise: dimensiuni mici, 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

Circumscrise

Difuze

Pneumotor

BPOC scleroemfizematos

CPC

Imagini mixte pulmonare

• 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

Hidropneumotorace

Abces pulm partial evac

S mb ondulante