3. imagistica pneumopatiilor interstitiale difuze sibiu 2014.pdf

8/19/2019 3. Imagistica pneumopatiilor interstitiale difuze Sibiu 2014.pdf

1/74

Claudia Toma

Universitatea de Medicina si Farmacie Carol Davila

Institutul de Pneumoftiziologie Marius Nasta

Bucuresti


2/74


3/74


4/74

Boli pulmonare

parenchimatoase

difuze (DPLD)

De cauza cunosc.(medicam)/

Colagenoze (PR)

/LIP

Pneumopatiiinterst idiopatice

(PII)

Fibrozante

cronice

Fibroza pulm.Idiopatica -

FPI (UIP)

PII non-

specifica

(NSIP)

Boligranulomatoase

(sarcoidoza, PN HSb)

Alte forme(LAM, Histiocitoza

cu cel Langerhans),

Pneumonia eozinof.

Non-familiale Familiale

(>80%) (2-20%)

Fibrozante

acute/subacute

Legate de

fumat

Pneumonia

criptogenica

in organizare

(BOOP/COP)

Pneumonia

interstitiala

acuta (AIP)

Pneumonia

interstitiala asociata

bronsiolitei resp.

(RB-ILD)

Pneumonia

interstitiala

descuamativa (DIP) 2014


5/74

Pneumopatie interstitiala

(imunocompetent)

Istoric, Ex. Clinic, Lab (uzuale), Rx (vechi/recente), PFR

(stabilirea cronicitatii/progresiei/stabilitatii)

Niciun alt demers

diagnostic

Recuperare clinica?

2014

Inlaturare/evitare a unei cauze potential identificabile

(ambientala/iatrogena)

Demers diagnostic

Serologie (colagenoze)

Biopsie (cutan, mm, sinus/sept nazal, ren.)

Boala sistemica specifica?

DA NU

DA NU

Evaluare +

Management

al bolii respective

HRCT

(analiza pl./ ple./mediast. pt

stabilire pattern PID +

alegere loc de LBA/biopsie)


6/74

2014

Sugestiv de:

Sarcoidoza, Berilioza,

Pneumonita de HSb,Limfangita carcinom,

Histiocitoza, Pneumonie

eozinof.

Elemente clasice de UIP?DA

NU

Bronhoscopie cu LBA si

Biopsie transbronsica

HRCT

(analiza pl./ ple./mediast. pt

stabilire pattern PID +

alegere loc de LBA/biopsie)

Fibroza pulm. idiopatica

(nu necesita alta confirmare)

Non-diagnostice Diagnostice

Pattern incert / sugestiv

de NSIP, BOOP/COP

Biopsie pulm. chirugicala

(toracosopie/toracotomie)


7/74

Sindrom interstitial

Opacitati micronodulare

Opacitati liniare/reticulare

“Geam t”

“Fagure de miere”


8/74

Normala Opacitati

micronodul.

Opacitati

liniare/retic.

Condensari

alveolare

Infiltrate

fugace

Sarcoidoza Sarcoidoza Sarcoidoza Hemoragiaalveolara

BOOP/COP

PN HSb PN HSb PN HSb Pneumonia

eozinofilica

Sdr. Loeffler

Azbestoza Silicoza Pneumoconioze BOOP/COP ABPA

Bronsiolitaobliteranta

Bronsiolitaobliteranta

Histiocitoza Proteinoza HSb lamedicamente

Colagenoze Carcinomatoza Colagenoze

FPI (initial) FPI

LAM LAM

Pneumonitaradica

Medicamente


9/74

Apicala Bazala Periferica

Boli granulomatoare- Sarcoidoza- Histiocitoza

- PN HSb

FPI BOOP/COP

Pneumoconioze- Silicoza- Berilioza

PR asociata cu UIP Pneumonia eozinofilica

Colagenoze- PR- Spondilita ankilop.

Azbestoza

Pneumonita radica

Medicamente


10/74

Bronsiolita obliteranta

PN HSb


11/74

Miliara TB


12/74

Carcinomatoza pulmonara


13/74

Pneumonie atipica


14/74

Histiocitoza cu cel. Langerhans


15/74

NSIP


16/74

BOOP/COP


17/74

Proteinoza alveolara


18/74

LAM


19/74

Microchiste



20/74

FPI


21/74

HRCT (rezolutie inalta, cupe fine)Nativ/ cu substanta de contrast

Indicata in urmatoarele situatii:

• Simptome persistente (dispnee/tuse)

+Rx cu sdr. interstitial /normala

• In absenta unei boli obstructive/insuficienteicardiace


22/74

Opacitati

micronodul.

Opacitati

liniare/retic.

“

Geam

t”

Condensari

alveolare

Chiste

PN HSb PN HSb PN HSb Pneumoniaeozinofilica

Histiocitoza

RB-ILD Colagenoze RB-ILD COP LAM

Sarcoidoza Azbestoza DIP Proteinoza

Silicoza FPI Medicamente Limfom

Histiocitoza Hemoragie

alveolara

Hemoragie

alveolara

Carcinomatoza

Pneumonialipoida


23/74


24/74


25/74


26/74


27/74


28/74

De cauza cunoscuta colagenoze, medicam.)

Boli granulomatoase sarcoidoza, PN HSb)

Boli metabolice proteinoza, amiloidoza,

microlitiaza)

Boli cu formare de chiste pulmonare

Histiocitoza, LAM)

Bronsiolite, BOOP/COP

Pneumonia eozinofilica

Boli vasculare

Pneumopatiile interstitiale difuze idiopatice


29/74




microlitiaza)


Histiocitoza, LAM)



Boli vasculare



30/74

Barbat 62 ani

Dispnee

Artralgii


31/74


32/74




microlitiaza)


Histiocitoza, LAM)



Boli vasculare



33/74

Femeie 43 ani

Dispnee progresivade efort

Tuse seaca PFR – sdr. restrictiv

TLco


34/74


35/74

Barbat 60 ani

Fumator 20PA

Tuse seaca

Dispnee PFR – sdr restrictiv

usor, TLco


36/74


37/74




microlitiaza)


Histiocitoza, LAM)



Boli vasculare



38/74


39/74


40/74


41/74

Barbat 62ani

Dispnee de efort


42/74


43/74

Barbat, 31 ani

Nefumator

Dispnee progresiva de

efort PFR – sdr. restrictiv

sever; TLco


44/74

Microlitiaza alveolara


45/74




microlitiaza)


Histiocitoza, LAM)



Boli vasculare



46/74

Barbat, 31 ani

Fumator – 20PA Dispnee progresiva de

efort de 1an

PFR – VR , TLco


47/74


48/74

B, 20 ani

Fumator

Diabet insipid

Dispnee la eforturimici


49/74



50/74


51/74

Femeie, 42 ani

Dispnee progresiva de

efort PFR – sdr. restrictiv

– VR , TLco


52/74


53/74




microlitiaza)


Histiocitoza, LAM)



Boli vasculare



54/74

Barbat 29 ani

Dispnee recenta

Tuse seaca


55/74


56/74

Bronsiolita obliteranta


57/74

Barbat, 74 ani

Febra

Tuse seaca Dispnee


58/74


59/74




microlitiaza)


Histiocitoza, LAM)



Boli vasculare



60/74

Barbat 21 ani

Astm controlatterapeutic

Infiltrat in urma cu1 an LSD – trat. antiTB

Subfebra

Tuse

Eozinofilie sg.(1200/mmc)


61/74

Iun 2014 Aug 2014


62/74




microlitiaza)


Histiocitoza, LAM)



Boli vasculare



63/74

Femeie 70 ani

Tuse cu expectoratiemuco-purulenta de 2

sapt. Hemoptizii de 4 zile

Artralgii


64/74


65/74




microlitiaza)


Histiocitoza, LAM)



Boli vasculare



66/74

B, 45 ani Fumator 25PA

Dispnee de 9 luni

Rx toracica - normala


67/74


68/74

Barbat 65 ani

Fumator 40PA

Dispnee si tuse seaca

de 1 an Hipocratism digital


69/74


70/74


71/74


72/74

Raghu G. - Am J Respir Crit Care Med Vol 183. pp 788–824, 2011


73/74

PID– grup heterogen de boli grupate impreuna

datorita similitudinilor clinice si radiologice

Diagnosticul diferential – numar mare de boli

cu cauza cunoscuta/necunoscuta

HRCT are importanta majora in diagnostic

(decubit dorsal/ventral; inspir/expir;nativ/contrast)


74/74

Dragos Bumbacea

Casandra Cilt

Ionela Belaconi

Stefan Dumitrache-Rujinski

3. imagistica pneumopatiilor interstitiale difuze sibiu 2014.pdf

Documents