Sindroame de Con Dens Are Pulmonara

8/14/2019 Sindroame de Con Dens Are Pulmonara

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SINDROAME DE

CONDENSAREPULMONARA


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CONDENSARI PULMONAREPRODUSE

PRIN PROCESEINFLAMATORII

PNEUMONII

BRONHOPNEUMONII


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PNEUMONIILE

-bacteriene-virotice


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PNEUMONIILEBACTERIENE


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SINDROMUL FIZIC DECONDENSARE PULMONARA

Vibratii vocale accentuate

Submatitate Pectorilocvie afona

Suflu tubar

Raluri crepitante

Murmur vezicular / absent


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Pneumonii bacteriene

Ex:

Pn.pneumococica (Pn. Franca

lobara)Pneumonia cea mai fracventa, tabloutipic

Pn.stafilococica Pn. Streptococica

Pn. Klebsiela pn (bacil

Friendlander)


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PNEUMONIA FRANCALOBARA


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PNEUMONIA FRANCA LOBARA

Etiologie: Streptococcuspneumoniae

=Coc G+ in diplo

Cuprinde un segment / lob pulmonar

Evolutie in 3 faze

1.Debut2.Perioada de stare

3.Rezolutia


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DEBUT-1

FRISON solemnUnic si puternic

Durata 15 30minute

Urmat de

FEBRAinalta 390 400inplatou


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DEBUT-2

JUNGHI

Intens

Transfixiant

Accentuatde respiratie / tuse

Imobilizeaza pt. pepartea bolnava

Localizat: submamelonar / bazal

Atesta afectarea pleurala(ex.:pl.diafragmatica durere umar

copii durere proiectata abdominal


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DEBUT-3

TUSEA iritativa, seaca, la inceput

1 3 zile

- Insotita de expectoratie

ruginie aderentacontine fibrina si

hematii


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DEBUT-4

EXAMENUL GENERAL

tegumente calde (febril)

Stare generala alterata

Facies vultuos herpes labial ( toata fata)


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DEBUT-5

EXAMENUL APARATULUI RESPIRATOR INSPECTIE -respiratie superficiala ( prin

junghi)

-polipnee

PALPARE: vibratiile se transmit normal

PERCUTIE: discreta submatitate

AUSCULTATIE :Initial: tonalitatea si intensitateaMV

=respiratie inalta modificare timbru = inasprire MV

= respiratie suflanta

(suflu audibil mai ales in expir)


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PERIOADA DE STARE

Dupa 24 48 ore

Dureaza 7 10 zile Tabloul clinic al Sdr. de condensare

Febra in platou

Dispnee cu polipnee de tip inspirator Cianoza

Persista junghi cu intensitate

Tuse cu expectoratie ruginie ulteriorgalbuie

Facies vultuos (congestia obrazului de parteabolnava)

Icter( hemoliza, hepatita toxica satelita)


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PERIOADA DE STARE

EXAMEN TORACE

Inspectie : amplitudinea excursiicostale

de partea bolnava

Palpare : tansmitere V V Percutie : Matitate

Auscultatie : inlocuire MV cu suflu

tubar inconjurat de coroana decrepitante

(in dinamica initial domina crepitantelecaresunt ulterior inlocuite de suflul

tubar)


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Rezolutia

Matitate mai putin neta

/ dispare suflul tubar Reapar crepitantele = alte caractere

groase, inegale, mai

umede


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Vindecarea in crizis = brusca

Inaintea AB / pt. mureau in criza Starea Pt. se altereaza brusc

Febra urca la 400

delir

Tanspiratii abundente Febra normal Normalizare puls


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Vindecarea in lisis

Fara semne clinice particulare Starea generala se imbunatateste

Febra scade treptat

Tusea diminua apoi dispare


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LABORATOR

INFLAMATIE: leucocitoza cuneutrofilie, VSH, fibrinogen, CRP

BIOCHIMIE: bil.indirecta,

creatinina, uree

(oligurie)

SPUTA:

-Ex. Bacteriologic: frotiu, cultura=pneumococ


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CONFIRMARE

Ex RADIOLOGICopacitate triunghiulara

baza spre pleura

varful spre hil

intensitate subcostala,

omogena

corespunde afectarii unui segment/ lob


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Strep. pneumoniaepneumonia.

Right upper-lobe

consolidation

demonstrating a

pronounced air

bronchogram andabsence of

volume change.


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Bilateral lower-zoneconsolidation

(arrows).

Althoughpneumococcal

pneumonia is typicallyunifocal, multifocal

involvement is notuncommon.


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Very extensive

consolidationaffecting

more than one lobe in

the right lung. Thecentral lucency is due

to

cavitation anunusual

feature inpneumococcalpneumonia.


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FORME PARTICULARE

FORME ABORTIVE

vindecare spontana fara AB

PNEUMONIA BATRANULUI

tablou discret, evolutie severa

PNEUMONIA COPILULUI

junghi abdominal,varsaturi, semnemeningeale

ALCOOLICI

tulburari psihice, agitatiepsihomotorie


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EVOLUTIA

NATURALA

-Moarte in crizis

-Complicatii

SUBTRATAMENT

-Tineriimunocompetenti

vindecare in 5-6zile

-Complicatii labatrani, tarati

COMPLICATII Colaps Sepsisbacteriemie

:pericardita, endocardita,meningita, abces

cerebral, parotidita,nefrita,

Abcedare Pleurezie-Din perioada de stare: parapneumonica

= lichidserocitrin-Tardiv: metapneumonica

=de obiceilidchid

purulent


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PNEUMONIA STAFILOCOCICA Debut mai putin brutal

Stare generala mai grava

Clinica = dominata de dispnee si cianoza

Febra de tip remitent

Sputa mucopurulenta cu striatii sangvine Obiectiv: focare de condensare,

submatitati, respiratie suflanta, crepitante+ subcrepitante

Rx. = Focare multiple de condensare

pneumatocele pneumotorax

= defapt bronhopneumonie


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Staph. aureuspneumonia. Thiscavitary pneumoniawas

a community-acquiredinfection occurringtwo weeks after aninfluenza A infection.


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Staph. aureus pneumonia pneumatoceles.Appearances followingincomplete resolution of astaphylococcal pneumonia.

There are several thin-walled cysts consistentwith pneumatoceles. Suchpneumatoceles arecommon in children but

unusual in adults.


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Staph. aureusinfection in a drugabuser.

Multipledisseminatednodularconsolidations,confluent in theright lower zone;several havecavitated. Theappearances aretypical ofhaematogenous

dissemination.


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PNEUMONIA CU KLEBSIELLAPNEUMONIAE(Friedlander)

Favorizata de teren ( boli cronice,subnutritie)

Caracteristica = starea generalaf. grava

cu colaps incontext septic

Cianoza si dispnee intense

Sputa hemoptoica vascoasa

Sdr. De condensare discret conturat

Rx.: opacitati ce cuprind mai mult deun lob,


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Gram-negativepneumonia

(Haemophilusinfluenzae)

showing a typical

bronchopneumonicpattern ofheterogeneous

localizedconsolidation. Such

infections arecommonly basal.


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PRINCIPII GENERALE DETRATAMENT

Oxigen

Hidratare

Simptomatic (antipiretice, antitusive,fluidifiante sputa

Al complicatiilor

ETIOLOGIC = ANTIBIOTICE

Nespitalizati

7. tineri imunocompetenti 5-18 ani

( macrolide / tetracicline II)

9. > 18 ani : macrolide / FQ / AM/CL / DOXI)

Spitalizati: P Ceph 3 + macrolid / FQ*


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Tratament ETIOLOGIC SPECIFICdaca ag.etiologic este determinat +

antibiograma

Strep.pneumoniae

Penicilino sensibil =

AMP iv, amox po, M, pen G iv, doxi, O

CephP rezistent : FQ (moxi) / P ceph 3

H influenzae

-lactamaza + : AM/CL, O Ceph 2/3, P Ceph3

-Lactamaza : AMP iv, amox po, TMP/SMX,M


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TUBERCULOZA


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Primary tuberculosis in a child. There is homogeneous consolidationof the right middle lobe which partially obscures hilar adenopathy.

Additional right paratracheal node enlargement is present.


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Post-primary tuberculosis. There is gross mid- and upper-zone diseasecharacterized by areas of consolidation and cavitation. The cavitation is

particularly extensive on the right where some of the cavities contain airfluidlevels.


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Post-primary tuberculosis: tuberculous bronchopneumonia. Numerous 5mm nodular shadows are present in both lungs, sparing the right apex. Theseare consistent with acinar consolidation following the endobronchial spread of

tubercle bacilli from the left upper-zone cavity.


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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


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Post-primary tuberculosis: tuberculoma. A localized view of the left upperzone in a patient who has had a thoracoplasty. The uppermost 20 mm nodule iswell defined and proved to be a tuberculoma at surgery. The less well-definedlower nodule had developed over 1 year and was a bronchial carcinoma. Note

the scattered small calcified nodules.


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PNEUMONII

(NON BACTERIENE)INTERSTITIALE

atipice


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ETIOLOGIE

de regula virala,

dar si : chlamidii, micoplasme

CLINIC predomina:

Febra

Tuse cu expectoratie mucoasa saumucopurulenta

Sindrom bronsiticAstenie fizica, transpiratii nocturne


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Procesele infiltrative pulmonare

nu realizeaza

sdr. de condensareparenchimatoasa


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DIAGNOSTIC CLINIC

Element epidemiologic sugestiv

Sugerat de asocierea :Rinita

Angina eritematoasa

Bronsita

Semnele clinice sarace sunt

contrastante cu radiologia


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RADIOLOGIA

Desen accentuat

Opacitati liniare de ob.

Hilio-bazale,uni sau bilaterale

Uneori opacitatile micro- saumacronodulare au caracter tranzitor


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M l i A l f id d i i l


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Measles pneumonia. An example of a widespread primary viralpneumonia with extensive bilateral confluent consolidation.


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BRONHOPNEUMONIA


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BRONHOPNEUMONIA Sindrom anatomo-clinic de cauze multiple, cu

evolutie neregulata, prognostic rezevat Afecteaza varstele extreme sau persoanele

tarate

Pot fi : primare / secundare

PRIMARE:Copii, batrani, tarati (asociatii microbiene)

SECUNDARE

-mai frcevente

-cauze predispozante:

infectii pulmonare variate (microbiene, virale)

Aspiratie

Inhalare subst.toxice


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BRONHOPNEUMONII

SIMPTOME discrete / absente

cu stare generala grava

DEBUT necaracteristic, insidios

STARE GENERALA alterata, grava

Frisonul , junghiul pot lipsi

FEBRA creste treptat , este

neregulata, creste din nou cand apare unnou focar, scade litic la sfarsitul bolii


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TUSEA cu expectoratia mucopurulentaare rar striatii hemoragice

CIANOZA intensa de tip central (buze siextremitatilor)

DISPNEEA

cu

POLIPNEE extrema (> 35 respiratii /min)

= pe primul plan + tiraj suprasternal siintercostal si bataia aripioarelor

nazale(copii)

/ sau Dispnee permanenta cu


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BRONHOPNEUMONIISEMNE FIZICE

totdeuna incontrast izbitor cugravitateasemnelor generalesi dispneea

variabile ca sediusi ca timp,modificandu-sicaracterele de la ozi la alta, uneorichiar in cateva ore

Variabile

Depind de

extindereaprocesului


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PERCUTIA

Modificari ( matitate )= doar in

bronhopneumoniile confluente care

imita pneumonia lobara

Focarele sunt localizate uzual in lobii

inferiori (exceptii: rujeola, tusea

convulsiva


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AUSCULTATIA :

Raluri bonsice diseminate= expresia bronsitei

- intre acestea = crepitatii in

teritoriul focarului lobular

RALURISUBCREPITANTE DE CALIBREDIFERITE


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Concluzie

Zone disparate darmultiple de congestie cu

respiratie suflanta, raluri bronsice, raluri

crepitante sisubcrepitante

si submatitati


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BRONHOPNEUMONIIEXAMEN RADIOLOGIC

Nu exista paralelism intre tabloul clinic sicel radiologic

Rx. Pune in evidenta focare

bronhopneumonice = umbre maireduse ca extindere, dar multiple, deintensitati variabile, cu contur

neregulat si rau delimitat Uneori exista si imagini mai dense


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BRONHOPNEUMONIICOMPLICATII

PRECOCE : LOCALE / GENERALE TARDIVE : bronsiectazia

Ex.:

soc septic cu tahicardie, hipotensiune,colaps, Insuf.renala, Insuf.card

Hipoxemie cu hipercapnie

Copii: cord pulmonar acut Prognosticul intotdeauna grav inaintea erei

antibioticelor ameliorat cu tratament etiologic(antiinfectios) si suportiv al complicatiilor


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INFLAMATIE: leucocitoza cuneutrofilie, VSH, fibrinogen,

CRP

BIOCHIMIE: bil.indirecta,

creatinina, uree(oligurie)

SPUTA:-Ex. Bacteriologic: frotiu, cultura

=pneumococ

-Celularitate: hematii, celule alveolare,


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CONDENSARI PULMONAREPRODUSE PRIN PROCESE

TUMORALE


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NEOPLASMUL BRONHOPULMONAR

Asociere de sindroameSdr de condensare retractil /neretractil

Sdr. Lichidian pleuralSdr. Mediastinopulmonar

Sdr cavitar


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In functie de localizare neo.:

HilarNodul periferic

Lobar

Segmentar

Sdr de condensara pulmonara = Rar


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ACUZE

TUSEExcitare vag

DUREREA

apare tardivcontinua, nelegata de respiratie

HEMOPTIZIE

Aspect jeleu de coacaze DISPNEEdaca bronsia principala este obstruata

EXAMEN FIZIC


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EXAMEN FIZIC

SDR. DE OBSTRUCTIE BRONSICA

LOCALIZATA OBSTRUCTIE PARTIALAwheezing localizatHipersonoritate localaSibilante + ronflante localizate vv, mv localizat

OBSTRUCTIE TOTALA= sdr. AtelectaticMatitate fara VV, fara MV

COMPLICATII OBSTRUCTIEPneumonii repetate in acelasi locabcese

SDR DETERMINATE DE INVAZIA LOCALA


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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,

edemin pelerina

Pleura = sdr.lichidian pleural

Pericard= revarsat lichidian/ tamponada Miocard= aritmii Catre inel toracic superior = sdr.Pancoast

(liza coastei 1- 2)


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SEMNE LEGATE DE METASTAZE

LIMFATICEGanglioni:hilari,

mediastinali,supraclaviculari

Limfangita carcinomatoasa

(dispnee, insuf. Respiratorie) HEMATOGENE

ficat, creier, SR, os


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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


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DIAGNOSTIC

Suspiciune clinica confirmata Rx, CT,bronhoscopie ( sputa),mediastinoscopie

TRATAMENT

Chimioterapie

Chirurgical

Radioterapie preoperator / paleativ


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INFARCTUL PULMONAR

Sdr. De condensare datoritainlocuirii aerului alveolar cu sange

Secundar obstructieei uni ram

a.pulmonara

Cauza favorizanta ( boli carefavorizeaza formarea trombilor

tromboze venoase profunde )


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CLINIC

DURERE TORACICAjunghi 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


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Subicter conjunctival

Cianoza buzelor

Tahicardie

Subfebra

Uneori semne de insuf cardiaca

dreapta


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INFARCT MIC

Submatitate

v v Respiratie inasprita

Frecaturi pleurale


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INFARCT MARE

submatitate

v v Respiratie suflanta / suflu tubar

Subcrepitante, crepitante Frecaturi pleurale

sdr. Lichidian pleural


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DIAGNOSTIC

Contextul clinic al bolii de fond

Rx

Opacitate triunghiulara cu baza sprepleura

marirea arterei pulmonare


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TRATAMENT

Al bolii de fond

ANTICOAGULANT

HEPARINE (UFH, LMWH)

ANTICOAGULANTE ORALE


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CONDENSARI PULMONARE

RETRACTILE

ATELECTAZIA

PULMONARA


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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


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ATELECTAZII lobare, segmentare

Durere

Tuse seaca

Cianoza

ATELECTAZII mici

=asimptomatice,descoperiteRx.


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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


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RADIOLOGICOpacitate omogena cu concavitatea spre

exterior intereseaza 1 segment, / un lob,/ un plaman

intreg

cu o intindere mai mica decat regiunea

respectiva in conditii normaleSpatii intercostale ingustate si mai oblice

Mediastin tractionat spre partea bolnava

Diafragm ascensionatMiscare inspiratorie a mediastinului spre

partea bolnava


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Right middle-lobeatelectasis in a 70-year-old female with chronicobstructive lung disease.(A) The frontal chestradiograph showsminimal blurring of theright heart border. (B) Thelateral chest radiographshows that the rightmiddle lobe is completelycollapsed. The depressedminor fissure (arrows),

and the anteriorlydisplaced major fissure(arrowheads) are almostapposed.

45-year-old man with left upper-lobe collapse due to endobronchial sarcoidosis. (A) The chest radiographshows 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


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lucent because it is occupied by the superior segment of the hyperinflated left lower lobe. The aortic arch issharply 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 scanshows the complete left lower-lobe collapse, and endobronchial obstruction of the left upper-lobe bronchus

(arrow). No extrinsic component is shown.


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Figure 19-22Bilateral lower-lobecollapse, presumed due tomucoid impaction, in a 63-year-old man following abdominalsurgery. (A) The frontal chestradiograph shows the triangularoutlines of the collapsed lowerlobes (sail sign) (arrows). Bothhila are depressed. The medialportions of the diaphragm areobscured. The collapsed left lowerlobe is almost exactlysuperimposed on the heart. (B) A

lateral chest radiograph showsthe collapsed lobes overlying thespine (arrows). The posteriorportions of both hemidiaphragmsare obscured.


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Combined right middle and rightlower-lobe collapse in a 66-year-old woman withbreathlessness followingabdominal surgery. The frontalchest radiograph shows combinedright middle lobe and right lower-lobe collapse. Arrows indicate theminor fissure. Arrowheadsindicate the major fissure. Themultilobar collapse simulates aright pleural effusion, but themarked inferior hilar

displacement, the markeddepression of the right majorfissure, and the ipsilateralmediastinal shift are importantclues that this is a volume-losingprocess A decubitus view showed

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Sindroame de Con Dens Are Pulmonara