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CONDENSARI PULMONARE PRODUSE PRIN PROCESE TUMORALE - NEOPLASMUL BRONHOPULMONAR
Asociere de sindroame
Sdr de condensare retractil / neretractil
Sdr. Lichidian pleural
Sdr. Mediastinopulmonar
Sdr cavitar
In functie de localizare→ neo.:
Hilar
Nodul periferic
Lobar
Segmentar
Sdr de condensara pulmonara = Rar
ACUZE
TUSE
Excitare vag
DUREREA
apare tardiv
continua, nelegata de respiratie
HEMOPTIZIE
Aspect "jeleu de coacaze"
DISPNEE
daca bronsia principala este obstruata
EXAMEN FIZIC
SDR. DE OBSTRUCTIE BRONSICA LOCALIZATA
OBSTRUCTIE PARTIALA
wheezing localizat
Hipersonoritate locala
Sibilante + ronflante localizate vv, ↓ mv → localizat
OBSTRUCTIE TOTALA = sdr. Atelectatic
Matitate fara VV, fara MV
COMPLICATII OBSTRUCTIE
Pneumonii repetate in acelasi loc
abcese
SDR. DETERMINATE DE INVAZIA LOCALA
INVAZIA MEDIASTINULUI
N. recurent = paralizie coara vocala,raguseala
Frenic = paralizie diafragm, durere cu iradiere spre gat
Esofag = tulburari de deglutitie
Vag = dispnee, constipatie
Simpatic cervical = sdr Claude-Bernard- Horner
Trahee = stridor, dispnee
Vena cava superioara = jugulare turgescente, edem in pelerina
Pleura = sdr.lichidian pleural
Pericard = revarsat lichidian/ tamponada
Miocard = aritmii
Catre inel toracic superior = sdr.Pancoast
(liza coastei 1- 2)
SEMNE LEGATE DE METASTAZE
LIMFATICE
Ganglioni:
hilari,
mediastinali,
supraclaviculari
Limfangita carcinomatoasa
(dispnee, insuf. Respiratorie)
HEMATOGENE
ficat, creier, SR, os
SINDROAME SISTEMICE
↓ G
Febra
Sdr. Endocrine
Afectare nervoasa paraneo= neuropatie periferica
Sdr. Miastenic, polimiozita
Sdr.reumatismale
Osteoartropatia Pierre Marie
Sdr. Dermatologice: dermatomiozita, achantosis nigricans
Tromboflebite migratorii (Trouseau)
Endocardita nebacteriana
Hematologice: anemie, Tpenie, CID
Glomerulopatie membranoasa
DIAGNOSTIC
Suspiciune clinica confirmata Rx, CT, bronhoscopie (± sputa), mediastinoscopie
TRATAMENT
Chimioterapie
Chirurgical
Radioterapie preoperator / paleativ
INFARCTUL PULMONAR
Sdr. De condensare datorita "inlocuirii aerului alveolar cu sange"
Secundar obstructieei uni ram a.pulmonara
Cauza favorizanta ( boli care favorizeaza formarea trombilor - tromboze venoase profunde )
CLINIC
DURERE TORACICA
junghi exacerbat de tuse si respiratie,
decubit lateral pe partea sanatoasa)
DISPNEE
ANXIETATE
Expectoratie HEMOPTOICA la cateva ore de la aparitia junghiului /
Sau tuse seaca cu caracter pleural
Subicter conjunctival
Cianoza buzelor
Tahicardie
Subfebra
Uneori semne de insuf cardiaca dreapta
INFARCT "MIC"
Submatitate
↑ v v
Respiratie inasprita
Frecaturi pleurale
INFARCT "MARE"
submatitate
↑ v v
Respiratie suflanta / suflu tubar
Subcrepitante, crepitante
Frecaturi pleurale
± sdr. Lichidian pleural
DIAGNOSTIC
Contextul clinic al bolii de fond
Rx
Opacitate triunghiulara cu baza spre pleura
± marirea arterei pulmonare
TRATAMENT
Al bolii de fond
ANTICOAGULANT
HEPARINE (UFH, LMWH)
ANTICOAGULANTE ORALE
CONDENSARI PULMONARE RETRACTILE
ATELECTAZIA PULMONARA
Resorbtia aerului alveolar de cauza mecanica (frecvent obstructie bronsica)
Sdr de condensare cu tractiunea organelor din jur spre partea bolnava
Simptomatologia in functie de rapiditatea instalarii
ATELECTAZII lobare, segmentare
Durere
Tuse seaca
Cianoza
ATELECTAZII mici
=asimptomatice,descoperite Rx.
Hemitorace afectat mai mic de volum
Adancirea fosei supraclaviculare de parea bolnava
Ingustarea spatiilor intercostale
↓ amplitudinea excursiilor costale
Palpare: vv ↓ / abolite
Percutie : matitate
Auscultatie: ↓ / abolire mv
RADIOLOGIC
Opacitate omogena cu concavitatea spre exterior
intereseaza 1 segment, / un lob,/ un plaman intreg
cu o intindere mai mica decat regiunea respectiva in conditii normale
Spatii intercostale ingustate si mai oblice
Mediastin tractionat spre partea bolnava
Diafragm ascensionat
Miscare inspiratorie a mediastinului spre partea bolnava
Right middle-lobe atelectasis in a 70-year-old female with chronic obstructive lung disease. (A) The frontal chest radiograph shows minimal blurring of the right heart border. (B) The lateral chest radiograph shows that the right middle lobe is completely collapsed. The depressed minor fissure (arrows), and the anteriorly displaced major fissure (arrowheads) are almost apposed.
45-year-old man with left upper-lobe collapse due to endobronchial sarcoidosis. (A) The chest radiograph shows hazy opacity over the left chest, with obscuration of the left heart border. The apex of the left lung appears lucent because it is occupied by the superior segment of the hyperinflated left lower lobe. The aortic arch is sharply outlined by the hyperinflated left lower lobe. (B) The lateral view shows the hyperinflated left lower lobe interfacing anteriorly with the collapsed left upper lobe along the major fissure (arrows). (C) An axial CT scan shows the complete left lower-lobe collapse, and endobronchial obstruction of the left upper-lobe bronchus (arrow). No extrinsic component is shown.
Figure 19-22 Bilateral lower-lobe collapse, presumed due to mucoid impaction, in a 63-year-old man following abdominal surgery. (A) The frontal chest radiograph shows the triangular outlines of the collapsed lower lobes ('sail sign') (arrows). Both hila are depressed. The medial portions of the diaphragm are obscured. The collapsed left lower lobe is almost exactly superimposed on the heart. (B) A lateral chest radiograph shows the collapsed lobes overlying the spine (arrows). The posterior portions of both hemidiaphragms are obscured.
Combined right middle and right lower-lobe collapse in a 66-year-old woman with breathlessness following abdominal surgery. The frontal chest radiograph shows combined right middle lobe and right lower-lobe collapse. Arrows indicate the minor fissure. Arrowheads indicate the major fissure. The multilobar collapse simulates a right pleural effusion, but the marked inferior hilar displacement, the marked depression of the right major fissure, and the ipsilateral mediastinal shift are important clues that this is a volume-losing process. A decubitus view showed only minimal right pleural fluid
TUBERCULOZA
Clasificare
In raport cu momentul infectiei
PRIMARA
SECUNDARA
In functie de localizare:
Pulmonara
Pleurala
Ganglionara periferica
Osteo-articulara
Uro-genitala
Miliara
Meningeala
Peritoneala
Tuberculoza aparatului respirator
90% din cazuri
Infectia preponderent pe cale AERIANA
TUBERCULOZA PRIMARA
Primoinfectia manifesta simpla
Radiologic:
Complex primar simplu:
Afect primar
- in vercinatatea pleurei viscerale
- vizulizat Rx dupa vcalcificare
Adenopatie satelita
TUBERCULOZA SECUNDARA
Elemente de diagnostic
Ancheta epidemiologica
Testarea tuberculinica
Tabloul clinic
Manifestari generale de " impregnare bacilara"
Astenie fizica
Subfebra(febra) vesperala
Scaderea ponderala
Transpiratii nocturne
Eritem nodos
Hepatosplenomegalie
Manifestari pulmonare
Tusea cronica > 3 saptamani
Dispneea
Durerea toracica surda
Hemoptizia
Confirmare
Radiologica
bacteriologica
Tuberculoza Sistemului Nervos Central
MENINGO-ENCEFALITA TBC
Febra
Cefalee
Fotofobie
Redoarea cefei
Confuzie
Semne neurologice!paralizii de nervi cranieni
Diagnostic: analiza LCR
TUBERCULOZA GANGLIONARA
Cea mai comuna afectare extrapulmonara
Localizarea la nivel gg.Cervicali = "scrofuloza"
+ Alte localizari ganglionare
INSPECTIE/PALPARE
Nedurerosi
fluctuenti→ fistulizare →secretii in care se identifica BK
TUBERCULOZA URO-GENITALA
Tuberculoza urinara:
Manifestari urinare:
disurie
hematurie, proteinurie, piurie
Tuberculoza genitala:
Prostata
Vezicule seminale
Epididim
Salpingita tbc
TUBERCULOZA OSTEOARTICULARA
Diseminare hematogena
Afectate
Frecvent coloana vertebrala( →gibozitate )
Clinic
Durere
Limitartea miscarilor
Abcese reci de vecinatate palpabile
Latenta mare a diagn.
Diagnostic : RADIOLOGIC
TUBERCULOZA APARATULUI DIGESTIV
INTESTINALA
Inapenta, scadere ponderala, dureri abdominale, alternanta diaree-constipatie
Mase pseudotumorale palpabile
→ obstructii
→ fistule
→ hemoragii digestive
TUBERCULOZA APARATULUI DIGESTIV
PERITONEALA
Peritonita cronica adeziva
Inapetenta, deficit ponderal, subfebrilitate, mase tumorala abdominale
Ascita"nedureroasa"
Triada: ascita, febra, IDR pozitiv
TUBERCULOZA HEPATICA / SPLENICA
Post-primary tuberculosis. There is gross mid- and upper-zone disease characterized by areas of consolidation and cavitation. The cavitation is particularly extensive on the right where some of the cavities contain air-fluid levels.
Post-primary tuberculosis: tuberculous bronchopneumonia. Numerous 5 mm nodular shadows are present in both lungs, sparing the right apex. These are consistent with acinar consolidation following the endobronchial spread of tubercle bacilli from the left upper-zone cavity.
Post-primary tuberculosis: miliary tuberculosis in an adult man. Diffuse nodulation is present in all zones. Nodules are approximately 1 mm in diameter and well defined.
Post-primary tuberculosis: tuberculoma. A localized view of the left upper zone in a patient who has had a thoracoplasty. The uppermost 20 mm nodule is well defined and proved to be a tuberculoma at surgery. The less well-defined lower nodule had developed over 1 year and was a bronchial carcinoma. Note the scattered small calcified nodules.
