radio imag.splenica
TRANSCRIPT
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©Rad/imag.Iasi-2003©Rad/imag.Iasi-2003
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RADIOGRAFIA ABDOMINALA STANDARD RADIOGRAFIA ABDOMINALA STANDARD
ECOGRAFIAECOGRAFIA
COMPUTERTOMOGRAFIACOMPUTERTOMOGRAFIA
ANGIOGRAFIA ANGIOGRAFIA
SCINTIGRAFIA
IMAGISTICA PRIN REZONANTA MAGNETICA
METODE DE EXPLORAREMETODE DE EXPLORAREMETODE DE EXPLORAREMETODE DE EXPLORARE
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ECOGRAFIA ESTE METODA INITIALA => eficace 85%ECOGRAFIA ESTE METODA INITIALA => eficace 85%
- - detecteaza modificarile de volum si de structura ale splinei - in patologia traumatica evidentiaza modificarile de structura, lichidul liber perisplenic sau intraperitoneal - studiu Doppler( color, duplex Doppler, Power Doppler) – util pentru evaluarea vaselor splenice
COMPUTERTOMOGRAFIACOMPUTERTOMOGRAFIA
Examinarea CT, este o metoda foarte utila in studiul patologiei splenice, efectuandu-se nativ (vizualizarea calcificarilor) si cu substanta de contrast.
Indicatie majora – Traumatismele abdominale!!Indicatie majora – Traumatismele abdominale!!
METODE DE EXPLORAREMETODE DE EXPLORAREMETODE DE EXPLORAREMETODE DE EXPLORARE
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RADIOGRAFIA ABDOMINALA STANDARDRADIOGRAFIA ABDOMINALA STANDARD
1. Ruptura splinei sau hemoragia pot determina cresterea “umbrei” splinei, normal delimitata de grasimea perisplenica 2. Splenomegalia determina ascensionarea hemidiafragmului stang, deviatia spre linia mediana a camerei cu aer a stomacului – semne indirecte 3. Calcificarile pot fi determinate de: calcificari arteriale, anevrism, chisturi calcificate, infarct splenic, infectii cronice granulomatoase
SCINTIGRAFIA
Utilizarea technetiului-99m sulfur coloid permite evaluarea sistemului reticuloendotelial . Indicatii: infarct splenic, anomalii de dezvoltare, postoperator.
METODE DE EXPLORAREMETODE DE EXPLORAREMETODE DE EXPLORAREMETODE DE EXPLORARE
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CALCIFICARI SPLENICE CALCIFICARI SPLENICE
Radiografie abdomen -Radiografie abdomen -profilCalcificare perete chist
CT: chist parazitar
CTCT: TBC- calcificari punctiforme splenice si hepatice
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IMAGISTICA CU REZONANTA MAGNETICAIMAGISTICA CU REZONANTA MAGNETICA
Senzitivitatea examenului prin rezonanta magnetica de a detecta leziunile focale si infiltrative ramane controversat.
ANGIOGRAFIA SI PROCEDURILE INTERVENTIONALEANGIOGRAFIA SI PROCEDURILE INTERVENTIONALE
1. Embolizare terapeutica – hipersplenism , anemia microsferocitara Minkovski-Chaufard, etc
2. Drenaj percutan al abceselor splenice – alternativa eficienta a gestului chirurgical
METODE DE EXPLORAREMETODE DE EXPLORAREMETODE DE EXPLORAREMETODE DE EXPLORARE
©Rad/imag.Iasi-2003©Rad/imag.Iasi-2003
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ANOMALII CONGENITALEANOMALII CONGENITALE - polisplenia , asplenia, spline accesorii
SPLENOMEGALIASPLENOMEGALIA Valori normale : Valori normale : ddiametrul transversal 7-10 cm, diametrul antero-posterior 4-6 cm, diametrul cranio-caudal = 11-15 cm
Inflamatorie - septicemie, abces, tbc, bruceloza, sarcoidoza Prin obstructie intrasplenicaPrin obstructie intrasplenica - ciroza hepatica, tromboza venei porte, insuficienta cardiaca dreapta De incarcareDe incarcare - amiloidoza, hemosideroza, hemocromatoza Prin tulburari ale hematopoiezeiPrin tulburari ale hematopoiezei - anemie hemolitica, talasemie, purpura trombocitopenica. Tumorala Tumorala - tumori maligne – limfoame, MTS
PATOLOGIE SPLENICAPATOLOGIE SPLENICAPATOLOGIE SPLENICAPATOLOGIE SPLENICA
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US: SPLENOMEGALIE
ciroza;hipertensiune portala
Circulatie colaterala
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LEZIUNI CHISTICE
CY
CTCT: imagini hipodense, hepatice si splenice, absenta enhancementului
Ficat
Splina
CY
Ecografie:Ecografie: imagine transonica, fine septuri in interior
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ECOGRAFIE ABCESE SPLENICE
Leziune unica
Splenomegalie, cirozaMicroabcese
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SPLINA SPLINA TUMORALA: TUMORALA:
metastazemetastaze
CTCT: leziune unica
Ecografie:Ecografie:Multiple imagini “in tinta”
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SPLINA TUMORALA SPLINA TUMORALA LIMFOM MALIGNLIMFOM MALIGN
Ecografie:Ecografie:Splenomegalie,
Infiltratie tumorala
T
CTCT: leziune pol superior©Rad/imag.Iasi-2003©Rad/imag.Iasi-2003
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INFARCTUL SPLENIC - este secundar unei obstructii trombo-embolice a arterei splenice sau a ramurilor sale.- embol - boala mitrala, infarct miocardic, - tromb - ATS, infiltratie vasculara - leucemia mieloida - evolutie - lichefiere, calcificare, transformare in pseudochist
LEZIUNI TRAUMATICE ALE SPLINEI
Leziuni focaleLeziuni focale - hematom subcapsular, fractura splenica
Leziuni difuzeLeziuni difuze - ruptura splenica, laceratia
Semne indirecteSemne indirecte - hematom perisplenic, hemoperitoneu, fracturi costale, pleurezie
HemoperitoneulHemoperitoneul - bine vizibil in primele 24-48 de ore
PATOLOGIE SPLENICAPATOLOGIE SPLENICAPATOLOGIE SPLENICAPATOLOGIE SPLENICA
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HEMATOM SUBCAPSULAR SPLENIC
Ecografie mod BEcografie mod BImagine hipoecogena
lenticulara subcapsulara CT postcontrastCT postcontrast Imagine hipodensa
lenticulara subcapsulara©Rad/imag.Iasi-2003©Rad/imag.Iasi-2003