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Atelectazia:
Postobstructiv
Non-obstructiv de obicei datorat pierderii contactului
dintre foiele pleurale
A 1988 study of 270 patients after elective intraabdominal surgery found that neither the presence nor the
absence of fever can assure clinicians of the presence or absence
of a postoperative pathologic pulmonary complication such as
atelectasis. Roberts J, Barnes W, Pennock M, Browne GD. Diagnostic
Accuracy of Fever as a Measure of Postoperative Pulmonary
Complications. Heart Lung. 1988 Mar;17(2):166-70
Semne Xray
Directe:
Deplasarea fisurilor
Creterea densitii lobilori pulmonari
Bronhograme aerice non arhitectonice(postobstructive)
sau vase
Indirecte:
Deplasareastructurilor hilare
Deplasarea ipsilateral a mediastinului
ngustarea ipsilateral a spaiilor intercostale
Elevarea ipsilateral a hemidiafragmului
Hiperextensia plamnului sntos
Obscured structures adjacent to atelectasis
Semne tipice de
atelectazie:
1) creterea densitii
LSS(semn direct)
2) Deplasarea traheei
spre stnga(semn
indirect)
3) Semnul
Felson(semn indirect)
Colaps lobar
Anatomie
Anatomie
Anatomie
Anatomie
Atelectazie de LSD
Semne Rx:
Elevarea hilului stng sau a fisurii mici
Lobul colabat se deplaseaz cranial i medial
n neo central, fisure mic se deplaseaz cranial
cu o convexitate lateral superior i
convexitate medial inferior (semnul S a lui
Golden)
Atelectazie de LSD:
LSD atelectatic
formeaz opacitate
triunghiular(sgea
ta)
Fisura mic elevat
formeaz un S
inversat (S-sign of
Golden) mpreun
cu masa hilar (M).
Atelectazie de LM
Profil:
Sgeile indic
fisurile mare i mic
paralele.
LM este opacifiat
ntre fisuri.
Atelectazii de LID
Atelectazie de LID
Opacitate
triunghiular n
hemitoracele
inferior drept.
Marginea lateral
este format de
fisura mere (normal
invizibil pe Rx de
fa).
Hilul drept deplasat
caudal.
Atelectazie de LSS
Elevare de hemidiafragm
Atelectazie LSS la un
pacient cu fisur
mare incomplet:
opacitate bine
definit.
Deviaia traheei spre
stnga i
tracionarea hilului
cranial
Sgeata indic
transparena
vertical delimitat
ntre arcul aortei i
marginea LSS
colabat (Luftsichel).
Atelectazie de LIS
Deviarea traheei
la stnga
Opacifierea
complet a
hemitoracelui
Semnul Felson
Deplasarea
cordului la
stnga
Mecanismele atelectaziei
Obstructive
Nonobstructive
Atelectazii obstructive
Cauze
Cauze
Atelectazii nonobstructive
1)
2)
3)
4)
Pasive
Compresive
Prin cicatrizare
Adezive
Pasiv
Passive atelectasis:
Notice the crowded
air bronchograms
(arrows) in the
setting of a left
pleural effusion. Air
bronchograms are
not present in postobstructive
atelectasis.
Compresiv
Compressive
atelectasis: Chest
x-ray showing a
giant bulla
occupying more
than two thirds
of the right
hemithorax and
compressing the
underlying lung
upward and
toward the
mediastinum.
Crowded air
bronchograms
can be seen
(arrows).
Adeziv
Adhesive atelectasis
in infant with
hyaline membrane
disease: CXR
reveals bilateral
ground-glass
appearance of the
lungs (atelectasis)
and air
bronchograms
standing (red
arrow) out against
the collapsed
parenchyma.
Cicatrizare
boli granulomatoase
Sechele postTB
Pneumonia necrozant
Iradierea
Pneumoconioze
Cicatrization atelectasis:
Lung destruction in patient
with chronic pulmonary
tuberculosis.
Bibliografie:
Sharma, Sat. Atelectasis. e-medicine, 2004.
http://www.emedicine.com/med/topic180.htm#section~pictures
2) Brad H. Thompson, M.D., William J. Lee, B.S., Jeffrey R. Galvin, M.D. and
Jeffrey S. Wilson, M.D Lobar Anatomy ElectricLungAnatomy
www.vh.org/adult/provider/radiology/LungAnatomy/LobarAnat/LobarAnat.
html
3) Daffner, RH. Clinical Radiology The Essentials. Williams and Wilkins,
1993, pp 80-85.
4) Engoren, Milo. Lack of Association Between Atelectasis and Fever.
Chest. Volume 107(1) January 1995pp 81-84
5) Roberts J, Barnes W, Pennock M, Browne GD. Diagnostic Accuracy of
Fever as a Measure of Postoperative Pulmonary Complications. Heart
Lung. 1988 Mar;17(2):166-70
6) Stark, Paul. Atelectasis: Types and Pathogenesis. UpToDate, 2004.
7) Stark, Paul. Radiologic Patterns of Lobar Atelectasis. UpToDate, 2004.
8) Weed HG, Baddour LM. Postoperative Fever. UpToDate, 2004.
9) Federico Venuta and Tiziano de Giacomo. Giant Bullous Emphysema.
CTSNET Experts' Techniques, General Thoracic Experts' Techniques.
http://www.ctsnet.org/doc/6761
1)