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    1 Investigatii in Pneumologie

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    Leonard D
    This document summarizes various radiological procedures used to investigate the respiratory system: 1. It describes different radiological techniques like chest X-rays, CT scans, PET scans and their uses in evaluating conditions like lung cancer, pulmonary embolism, and mediastinal abnormalities. 2. It also discusses functional pulmonary tests to assess ventilation, perfusion, gas exchange and pulmonary mechanics. Tests include spirometry, plethysmography and gas diffusion measurements. 3. Additional procedures covered are bronchoscopy, bronchoalveolar lavage, bronchography, thoracentesis, mediastinoscopy and video-assisted thoracoscopy used to diagnose pleural and mediastinal diseases.

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    1 Investigatii in Pneumologie

    Uploaded by

    Leonard D
    3K views50 pages
    This document summarizes various radiological procedures used to investigate the respiratory system: 1. It describes different radiological techniques like chest X-rays, CT scans, PET scans and their uses in evaluating conditions like lung cancer, pulmonary embolism, and mediastinal abnormalities. 2. It also discusses functional pulmonary tests to assess ventilation, perfusion, gas exchange and pulmonary mechanics. Tests include spirometry, plethysmography and gas diffusion measurements. 3. Additional procedures covered are bronchoscopy, bronchoalveolar lavage, bronchography, thoracentesis, mediastinoscopy and video-assisted thoracoscopy used to diagnose pleural and mediastinal diseases.

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    Cursuri Modulul Respirator Spitalul Marius Nasta

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    This document summarizes various radiological procedures used to investigate the respiratory system: 1. It describes different radiological techniques like chest X-rays, CT scans, PET scans and their uses in evaluating conditions like lung cancer, pulmonary embolism, and mediastinal abnormalities. 2. It also discusses functional pulmonary tests to assess ventilation, perfusion, gas exchange and pulmonary mechanics. Tests include spirometry, plethysmography and gas diffusion measurements. 3. Additional procedures covered are bronchoscopy, bronchoalveolar lavage, bronchography, thoracentesis, mediastinoscopy and video-assisted thoracoscopy used to diagnose pleural and mediastinal diseases.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    3K views50 pages

    1 Investigatii in Pneumologie

    Uploaded by

    Leonard D
    This document summarizes various radiological procedures used to investigate the respiratory system: 1. It describes different radiological techniques like chest X-rays, CT scans, PET scans and their uses in evaluating conditions like lung cancer, pulmonary embolism, and mediastinal abnormalities. 2. It also discusses functional pulmonary tests to assess ventilation, perfusion, gas exchange and pulmonary mechanics. Tests include spirometry, plethysmography and gas diffusion measurements. 3. Additional procedures covered are bronchoscopy, bronchoalveolar lavage, bronchography, thoracentesis, mediastinoscopy and video-assisted thoracoscopy used to diagnose pleural and mediastinal diseases.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 50

    Investigatia paraclinica a

    aparatului respirator

    Dr. Spanu Victor


    Radiologie I
    • Proceduri radiologice
    I . Radioscopia pulmonara
    Avantaje: aspect panoramic; contact direct; examen dinamic.
    Dezavantaje : nu ofera document obiectiv; adaptare la intuneric; omite
    imagini mici
    II . Radiografia pulmonara
    Avantaje : document; modificari fine
    Dezavantaje : imagine statica; imagini ascunse
    III . Tomografia plana
    Demonstrarea imaginilor cavitare
    IV . Radiofotografia
    Screening : tuberculoza ; cancer pulmonar ; boli profesionale
    Radiologie II
    • Defecte de tehnica : pozitionare ; regim
    (subexpunere , suprexpunere ); film ; developare
    (subdevelopare , supradevelopare )

    • Imagini parazite
    d) Schelet toracic : coasta bifida ; coaste
    supranumerare ; sinostoze costale ; tuberculi
    costali .
    e) Parti moi : musculatura toracica ; umbra sanilor ;
    sanii fetelor tinere ; sanii sclerosi ; rezectia
    sanului .
    Radiologie III

    • Aspecte normale
    Continator : coloana ; stern ; arcuri costale ;
    diafragm

    Continut : mediastin ; cimpurile pulmonare ; hilurile


    Radiologie IV
    • Opacitati pleuropulmonare :
    1.Localizare :
    • semnul siluetei ;
    • semnul Bernou ;
    • impartirea campurilor pulm. in regiuni ;
    • segmentatia .
    2. Forma :
    • lineare si in banda ;
    • reticulare ;
    • nodulare ;
    • rotund-ovalare ;
    • poligonale ;
    • policiclice ;
    • segmentare ;
    • intinse neregulate .
    3. Dimensiuni :
    • micronodulare ;
    • nodulare ;
    • macronodulare ;
    • intinse (sistematizate sau nesistematizate)
    4. Contur :
    • net ;
    • sters .
    5. Structura :
    • omogena ;
    • neomogena .
    6. Intensitate :
    • costala ;
    • subostala ;
    • supracostala
    Radiologie V
    • Hipertransparentele pulmonare
    - difuze
    - circumscrise : localizarea ; forma ; dimensiunile ; conturul interior .

    La opacitatea ce o delimiteaza descriem :


    - forma;
    - dimensiunea;
    - conturul;
    - structura;
    - Intensitatea

    • Imagini pulmonare mixte :


    - inaltimea nivel lichidian
    - rectitudinea nivelului
    Tomografie computerizata
    • Vizualizare superioara ex radiologic standard
    • Neoplasm pulmonar
    – Stadializare TNM
    • Formatiuni mediastinale
    • Diferentiere elemente hil (vase vs adenopatii) prin
    contrast iv
    • Structura parenchim pulmonar
    – Bronsiectazii
    – Chiste aerice
    – PID: aspecte tipice
    • Vase pulmonare: trombembolism (contrast)
    • Afectare pleurala: inchistari, mezoteliom
    • PET-CT
    – Tehnica compozita
    – PET: scintigrafie cu glucoza marcata, identifica
    zonele cu metabolism crescut
    • Noduli maligni, grasime bruna, creier
    – Indicatii:
    • Mai buna definire a extensiei TNM
    • Identificare recidive tumorale
    • Ultrasonografie toracica
    Aplicatii :
    – lichid pleural
    – inchistare
    • Scintigrafie toracica
    I . Ventilatie - Xenon 133
    II. Perfuzie - Tehnetiu 99
    Aplicatii :
    -tromembolismul pulmonar
    -cancerul pulmonar
    III. Galiu 67
    -inflamatie
    -celule neoplazice
    Explorarea functionala pulmonara
    • Ventilatia
    1.Volume si capacitati pulmonare :
    CV si subdiviziunile
    Direct : spirografie ; pneumotrahografie .
    Indirect : pletismografie (VGIT): VR , CPT
    2.Debite ventilatorii fortate :
    VEMS si VEMS/CV%
    Curba flux-volum expiratorie (PEF , MEF 50 , MEF 25)
    3.Mecanica pulmonara :
    Complianta pulmonara
    Rezistenta la flux in caile aerifere

    Datele obtinute permit caracterizarea DVO, DVR, DVM


    Explorarea functionala pulmonara
    -continuare-
    Perfuzia
    2. Cateterismul cordului dr. :
    -press. AP=22/9 mmHG
    -press.CP=8 mmHG
    2. Scintigrafia

    Schimbul gazos
    8. Factorul de transfer gazos (capacitatea de difuzie )
    9. Global : PaO2,PaCO2, P(A-a) O2 (gradientul alveolo-
    arterial al O2)
    Bronhoscopia
    • Bronhoscop flexibil • Bronhoscop rigid

    Indicatii diagnostice : Indicatii :


    -carcinomul bronsic -corpi straini
    -simptome respiratorii : hemoptizii; -hemoptizii masive
    wheez.loc. -stenoze traheale
    -sarcoidoza -chirurgie laser
    -tuberculoza
    -bacteriologie : tbc ; pneumocistis

    Indicatii terapeutice :
    -secretii
    -corpi straini
    -fistule ganglio-bronsice
    -carcinoame obstructive
    - Plasare de stenturi
    - Rezectii laser
    Lavajul bronhoalveolar
    • Aspiratul “simplu”
    - BAAR
    - Celule neoplazice
    - Flora nespecifica
    - Pneumocystis carinii
    • Lavajul bronhoalveolar “propriu-zis”
    “Biopsie lichida” datorita concordantei cu celularitatea interstitiului
    Normal :
    - nr. celule /ml = 200.000 din care:
    - Macrofage alveolare = 90%
    - Limfocite = 8%
    - Neutrofile = 1%
    - Eozinofile = 1%
    Aspecte caracteristice in : P.I.D. ; sarcoidoza ; A.A.E.
    Bronhografia
    • Identifica :
    -variante anatomice
    -malformatii
    -distorsiuni
    -obstructii distale

    Indicatia de electie :
    -bronsectazii (existenta, extinderea, rezecabilitatea)
    Toracenteza , biopsia pleurala
    • Toracenteza se practica pentru :
    – Diagnosticul oricarei colectii lichidiene pleurale
    – Evacuare lichid pleural (pleurezii recidivante, empiem)

    • Diagnostic: lichid pleural


    – Aspectul macroscopic al lichidului
    – Analize
    • Biochimice: proteine, glucoza, LDH
    – Adenozin-dezaminaza,
    • Citologie: hematii, neutrofile, limfocite, cel neoplazice
    • Bacteriologie: bK (cultura), bacterii
    • Alti factori: FR, complement, celule lupice
    Toracenteza , biopsia pleurala
    -continuare-

    • Biopsie pleurala
    – Recolteaza pe ac mic fragmente de pleura parietala
    – Indicatii :
    • pleurezia tuberculoasa (80% +) evidentiaza leziunea
    granulomatoasa cu necroza de cazeificare
    - cancerul pulmonar ( afectarea pleurala secundara )
    - Mezoteliom
    - Pleurezii in cadrul bolilor de sistem
    Examene de sputa
    • Diagnostic bacteriologic
    – bK
    – Bacterii (“flora banala”)
    – Fungi (aspergillus, candida!)
    • Diagnostic citologic
    – Sputa din mai multe zile colectata in formol
    • Examen sputa pentru bK
    – Sputa expectorata spontan
    – 3 produse insotite de un singur formular
    – Ex microscopic: Ziehl-Neelsen sau auramina-
    rodamina
    – Cultura: mediu Lowenstein / medii lichide
    – Antibiograma
    – Metode genetice: PCR
    • Examen bacteriologic al sputei (“flora banala”,
    “sputa spalata”)
    – Sputa expectorata spontan, matinal
    – Prelucrare in max 2 ore de la colectare
    – Tehnica de “spalare” pentru decontaminare orala
    – Ex. microscopic:
    • Criterii de validitate a produsului (<25% celule orale)
    • Coloratie Gram, criterii de patogenitate (germeni intracelulari)
    – Cultura in aerobioza: identificare germene patogen
    • Interpretare precauta: culturi polimicrobiene – probabil
    nevalide; germeni intestinali: nu au ce cauta in sputa
    (contaminare); germeni de colonizare si nu patogeni
    – Antibiograma

    – Decat un examen bacteriologic de proasta calitate, mai


    bine un tratament empiric bine judecat!
    Biopsia pulmonara
    • Biopsia pulmonara transbronsica
    Indicatii :
    -afectiuni pulm.difuze : alveolite fibrozante; sarcoidoze ;
    carcinom alveolar.
    -transplant pulmonar
    -infectii pe gazda compromisa
    • Biopsia percutana transtoracica
    Indicatii :
    -nodulul pulmonar periferic
    • Biopsia pe plaman deschis
    Toracoscopia,mediastinoscopia,
    mediastinostomia
    • Toracoscopia • Mediastinoscopia
    Indicatii : Indicatii :
    • pleurezii de etiologie – Biopsie adenopatii
    neprecizata mediastinale
    • mezotelioame • Neoplazici (stadiu N)
    • aderente • Sarcoidoza
    • pneumotorax spontan • Limfoame

    • fistule bronho-pleurale • Mediastinotomia


    • talcaj Indicatii :
    - Rezectii noduli pulmonari – Biopsie formatiuni
    - Biopsie pulmonara mediastinale anterioare
    Toracoscopie video-asistata
    Mezoteliom
    pleural

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