Zvirwere zve Chest Inopinda Kuongorora Kufananidza

Core Anatomy

• Cherekedza zvizvarwa zveiyo tracheal-bronchial muti, lobes, zvikamu, uye zvipuka. Cherekedza yechipiri pulmonary lobule (1.5-2-cm) -iyo yakakosha inoshanda unit yemapapu anoonekwa paHRCT. Cherekedza kurongeka kwakarongeka kwenzvimbo dzealveolar nekutaurirana pakati (pores yeKohn & migero yeLambert) iyo inobvumidza kufambiswa kwemhepo uye neiyo imwecheteyo nzira inobvumidza exudative kana transudative fluid kuti ipararire kuburikidza nemapapu uye yakamira pane iyo fissure. Cherekedza chimiro cheiyo pleura: parietal iyo iri chikamu che endothoracic fascia uye iyo visceral iyo inogadzira mapapu - nzvimbo yekumeso iri pakati.

 

 

• Mediastinum: yakakombwa ne pleura uye mapapu. Inogadzirisa zvivako zvakakura zvine lymph nodes dzakawanda (ona diagram inoratidza nhengo dzepasi-kati uye nhengo dzavo muLymphoma

 

 

Nzira Yese Yakagadzirirwa Kuongorora Mhosva Yechipfuva

• Radiographic examination (Chest X-ray CXR); yakanakisisa 1st danho. Kudhura kwakaderera, kuderera kwemazuva ano kuonekwa, kuongororwa kwakawanda kwekunyunyuta kwekliniki
• CT kuongorora: chifuva CT, High-Resolution CT (HRCT)
• Chep pathology approach:
• Trauma
• Kurwara
• Neoplasms
• Pulmonary edema
• Pulmonary emphysema
• Atelectasis
• Pleural pathology
• Mediastinum

PA & Yakazotevera CXR

 

• Mamwe maonero anogona kushandiswa:
• Isheotic maonero: anobatsira kuongorora apical nzvimbo
• Decubitus anoona kurudyi uye kuruboshwe: rubatsiro rwekuongorora tsvina yakawanda inonzi effusion, pneumothorax nezvimwe zvirwere

 

 

 

• Yakajairwa CXR PA & Ekupedzisira maonero. Ita shuwa kuratidzwa kwakanaka: T-musana disc uye midziyo kuburikidza nemoyo inoonekwa pane PA kuona. Verenga 9-10 kurudyi positi mbabvu kuti usimbise zvakakwana kukurudzira simba. Tanga ongororo yakakwana uchishandisa nzira inotevera: Pane Zvirwere Zvakawanda Zvemapapu A-dumbu / diaphragm, T-thorax madziro, M-mediastinum, L-mapapu zvakasiyana, Mapapu-ese ari maviri. Gadzira yakanaka yekutsvaga pateni

 

 

• 1) Chirwere chema Air aka alveolar lung chirwere? Kuzadza evhaveoli yemapapu, acini uye inotevera lobe yose ine mvura inenge yakasvibiswa kana yechinhu chero chipi zvacho (ropa, pus, mvura, proteinaceous material kana kunyange masero) Radiographically: lobar kana segmental distribution, airspace nodules inogona kuonekwa, chido chekubatana, mweya bronchograms uye chiratidzo chechi silhouette chiripo. Batwing (butterfly) kugoverwa kunoonekwa se (CHF). Kuchinja nokukurumidza kwenguva, kureva, kuwedzera kana kuderera (mazuva)
• 2) Kurwara kwepakati: chirwere chepermonary interstitium (alveoli septum, lung parenchyma, masvingo emadziro, nezvimwewo) nemuenzaniso nemavirusi, mabhakitiriya maduku, protozoan. Uyewo kupindira nemasero akadai semasero ekuvhiringidza / anouraya (semuenzaniso, lymphocytes) Anowanikwa sechirevo chepapu interstitium ne reticular, nodular, reticulonodular pattern. Kusiyanisa kwakasiyana-siyana: kupisa autoimmune zvirwere, fibrosing mapapu chirwere, chirwere chemapapu chebasa, chirwere chetachiona / mycoplasma, TB, sarcoidosis lymphoma / leukemia nezvimwe zvizhinji.

 

 

• Kuziva zviratidzo zvakasiyana zvezvirwere zvepermonary zvinogona kubatsira neDDx. Misa vs. Kurambidzwa (kuruboshwe). Cherechedza mararamiro akasiyana ezvirwere zveplummoni: chirwere chemhepo chinokonzerwa nekuputika kwechirwere chinoratidza chirwere chepineumia, kuparadzaniswa kwechirwere chekuona kwepermonary edema. Atelectasis (kuwa uye kurasikirwa kwevhu). Zvinyorwa zvinokonzera chirwere chepemmonary: reticular, nodular kana yakavhenganiswa. SPN vs. Multiple focal consolidations (nodules) zvichida inomiririra muto infiltrates vs. septic inopinda

 

 

• A = intraparenchymal
• B = kuderera
• C = extrapleura
• Ziva nzvimbo inokosha yepfupa remakumbo

 

 

• Zviratidzo zvinokosha: Silhouette chiratidzo: rubatsiro nekunzvimbo uye DDx. Muenzaniso: Mufananidzo wezasi uri kuruboshwe: radiopacity mumapapu akanaka, ari kupi? Kurudyi MM nokuti mwoyo wekodzero wakarurama uri pedyo nepakati yakarurama yepamusoro hauonekwi (silhouetted) Air bronchograms: mhepo ine bronchi / bronchioles yakakomberedzwa nemvura

 

 

Chest Trauma

• Pneumothorax (PTX): mhepo (gasi) mune nzvimbo yakazara. Zvikonzero zvakawanda. Matambudziko:
• Kutsigira PTX: kuenderera mberi kwekuwedzera kwemhepo munzvimbo inoshandiswa mhepo inokurumidza kusimbisa mediastinum uye mapapu zvinotadzisa kuderedza kudzoka kwemoyo kune mwoyo. Inogona kuuraya kana isingarapwa nokukurumidza
• PTX inongoerekana yaitika: vechidiki (vechidiki (30 -40) kunyanya vakareba, vatete varume. Zvimwe zvinokonzeresa: Marfan s syndrome, EDS, Homocystinuria, a - 1 -antitrypsin kushomeka. , lung fibrosis uye honeycombing, catamenial PTX d / t endometriosis nevamwe.
• Kutambudza pneumothorax: maperembudzi ekudzivirira, kushungurudzika kwakashata, iatrogenic (mafupa emapfupa, nezvimwewo) kugadzika, nezvimwewo.
• CXR: chinyorwa chinyorwa chinonzi pleural line aka aka lung edge. Kusabatwa kwezviputi zvemapurmoni / midziyo kunze kwekutenderera kwechirwere chekuona. Subtle pneumothorax inogona kushaikwa. Panzvimbo yakamira, mhepo inobuda uye PTX inofanira kutsvaga kumusoro.
• Rib fractures: v.common. Kushungurudzika kana kurwara (eg, mets, MM) Rib Rib series x - mazai haabatsiri nokuti CXR uye / kana CT kuongorora kunokosha zvikuru kuongorora PTX (pasi nechokuruboshwe) kugadzirisa mapapu uye imwe nzira huru

 

 

Kurwara

• Pneumonia: bhakitiriya inorwisana nevirwere kana fungal kana musingazivikanwi nemusikana (eg, Cryptococcus muHIV / AIDS) Pulmonary TB

 

 

• Pneumonia: inharaunda-inowanikwa nechepatara-inowanikwa. Izvozvo zvinokonzerwa nebhakitiriya pneumonia kana kuti Lobar (kwete-segmental) pneumonia ne purulent nyuchi ichizadza alveoli uye ichipararira kune rose lobe. M / C mhukaStreptococcus Pneumonia kana Pneumococcus
• Vamwe: (Staph, Pseudomonas, Klebsiella vari mune zvinodhakwa zvinogona kutungamirira kune necroSIS / mapapu emakumbo) Mycoplasma (20-30s) aka kufamba pneumonia, nezvimwewo.
• Muchiratidzo: kuora kunobudirira, fivha, kurwadziwa kwepfupa muchipfuva dzimwe nguva hemoptysis.
• CXR: mhepo yakasununguka inopindirana yakavharidzirwa kune lobe yose. Air bronchograms. Silhouette chiratidzo anobatsira nenzvimbo.
• Viral: Influenza, VZV, HSV, EBV, RSV, nezvimwewo zvinopa sepakati pemapapu chirwere chinogona kuwirirana. Inogona kutungamirira kune kuporesa kunokanganisa
• Atypical pneumonia uye Fungal Pneumonia: Mycoplasma, Legionnaire's disease, uye mamwe fungal / Cryptococcus pneumonia inogona kuve ne-interstitial lung disease.
• Kupamba kwepulmonary: chikwata chinotapukira che purulent nyamuviri mumapapu anowanzotapisa. Inogona kutungamirira kune zvakakosha mapemonary uye zvinetso zvehupenyu / hupenyu hunotyisidzira.
• Pamusoro peCXR kana CT: kuunganidza zvakapoteredza nemiganhu yakaoma uye necrosis inenge ine air-fluid level. DDx kubva empyema iyo inoparadzanisa mapapu uye kunyunyuta-kubva
• Rx: ma antibiotics, antifungal, antiviral agents.
• Pineumonia inofanira kuteverwa pamwe nekudzokorora CXR kuchengetedza kusarudzwa kwakakwana
• Kushayikwa kwehuwandu hwemhepo yepineumonia kunogona kureva kudzivirira mishonga, antibiotic resistance, pasi pepakenza carcinoma kana zvimwe zvinonetsa

Pulmonary TB

 

• Utachiona hunowanikwa munyika yose (nyika ye3rd nyika). 1 muvanhu vane 3 munyika yose inobatwa neTB. TB inokonzerwa naMycobacterium TB kana Mycobacterium Bovis. Intracellular bacillus. Macrophage ine basa rinokosha.
• Chekutanga Pulmonary TB & Post-primary TB. Inoda kudzokororwa kuratidzwa kuburikidza nekufema. Mune mazhinji masisitimu anokwanisa kuzvidzivirira, hutachiona hunoshingaira hahupo kukura
• TB inopa sa 1) yakabviswa nemuiti, 2) yakadzingwa muLatent Tuberculosis Infection (LTBI) 3) inokonzera chirwere chinoshanda cheTB. Varwere vane LTBI havaparadzi TB.
• Kufungidzira: CXR, HRCT. Primary TB: pulmonary airspace consolidation (60%) yakadzika lobes, lymphadenopathy (95% - hilar & paratracheal), pleural effusion (10%). Kupararira kwekutanga TB kunowanzoitika mune kusazvidzivirira uye vana.
• Milliary TB: pulmonary uye system complication kuparadzirwa kunogona kuuraya
• Post-primary (secondary) kana kuti reactivation infection: Kazhinji muApices nepamashure mapoka e-upper lobes) high PO2), 40% -kuvhiringidza zvipembenene, zvinokonzera kana zvinoputika airspace chirwere, fibrocalcific. Latent features: nodal calcifications.
• Dx: Acid-fast bacilli (AFB) smear uye tsika (sputum). Utachiona hweHIV mune varwere vose vane TB uye husingazivikanwi hweHIV
• Rx: 4-drug regimen: isoniazid, rifampin, pyrazinamide, uye ega ethambutol kana streptomycin.

Zvinyorwa zvePulmonary Neoplasms (kanhi yemukenza yemapapu vs. mastasia metastasis)

• Kanza yemaperembudzi: m / c kenza mumarume uye 6th kanama inowanzoitika kune vakadzi. Kushamwaridzana kwakasimba nejacinogens inhalation. Kliniki: kuwanikwa kwekupedzisira, zvichienderana nenzvimbo yechipfuva. Pathology (mhando): Small cell (SCC) vs. Non-small cell carcinoma
• Sero duku: (20%) rinobva paurouroendocrine Aka Kultchitsky cell, saka inogona kubudisa zvinhu zvinoshandiswa zvipenyu zvinopa neparaneoplastic syndrome. Inowanikwa nzvimbo yepakati (95%) pane kana pedyo ne-mainstem / lobar bronchus. Vazhinji vanoratidzira kusagadzikana uye kusakanganisika.
• Kwete-duku kero: Lung adenocarcinoma (40%) (Murefu wemapapu M / C), M / C kuvakadzi nevasiri vasvuta. Zvimwe: Squamous cell (inogona kuve neine cavitating lesion), Ikamu huru uye vamwe
• Firimu yeArain (CXR): chirwere chetsva kana chakawedzerwa, chinowedzera mediastinum zvinonzwisisika zvekushandiswa kwemuviri wecymph node, kuderera kwechisimba, atelectasis, nekubatanidzwa. SPN-inogona kureva kanzura yemapapu emapapu kunyanya kana ine mitsara isina kukwana, kupa zvikepe, masvingo akareba, mumapapu ekumusoro. Multiple lung lung nodules zvinogona kumira mastasisis.
• Nzira Yakanakisisa: HRCT ine kusiyana.
• Mimwe chipfupa neoplasms: Lymphoma ndeyev. Inowanikwa mubhokisi kunyanya mukati memasikati uye mukati mammary manotsi.
• Pakazara M / C pulmonary neoplasms ndeye metastasis. Mamwe mamota anoratidzira kufungidzira kwepamusoro kwemamapu emapapu, semuenzaniso, Melanoma, asi chero gomarara rinogona kusangana nemapapu. Mamwe mamets anonzi Cannonball metastasis
• Rx: radiation, chemotherapy, resection

 

 

• Pulmonary edema: izwi guru rinotsanangura kusachena kwemvura kunowedzera kunze kwezvivako zvevascular. Zvinowanzoparadzaniswa muCardiogenic (kureva, CHF, mitral regurgitation) uye Kwete-cardiogenic nehuwandu hwezvikonzero (semuenzaniso, kuwedzera kwemvura, mushure mekuisa ropa, zvinokonzerwa neurological, ARDS, pedyo nekudonhera / asphyxiation, heroin overdose, nezvimwe)
• Zvinokonzera: kuwedzerwa muHystrostatic pressure vs. kupera mu oncotic pressure.
• Kufungidzira: CXR uye CT: 2-types Interstitial uye Alveolar mafashamo. Kufananidza mharidzo kunobva pane zvikamu
• MuCHF: Stage 1: kuiswazve kwevascular kuyerera (10- 18-mm Hg) inozivikanwa se cephalization yeiyo pulmonary vasculature. Stage 2: Interstitial edema (18-25-mm Hg) Yepakati edema: peribronchial cuffing, Kerley mitsetse (lymphatics yakazadzwa nemvura) A, B, C mitsara. Stage 3: Alveolar edema: airspace chirwere: zvakasangana zvakasangana zvichikura kuita chirwere chemuchadenga chinopararira: Batwing edema, air bronchograms
• Rx: 3 zvinangwa zvikuru: Chekutanga O2 kuchengetedza O2 pa 90% kuwanisa
• Zvichizoitika: (1) kuderedzwa kwekudzoka kwepummonary venous (kuperevedza kunoderedza), (2) kuderedzwa kwe systemic vascular resistance (afterload reduction), uye (3) inotropic tsigiro. Tora zvinokonzera zvikonzero (semuenzaniso, CHF)

 

 

• Lung atelectasis: kusakwana kwekuwedzera kwepermonary parenchyma. Izwi rokuti "kupera mapapu" rinowanzochengeterwa apo mapapu ose aputsika
• 1) Kugadzirisa (kuvhiringidzika) atelectasis kunoitika semugumisiro wekudziviswa kwakakwana kwenzira inoenda kumhepo (semuviri, zvinoputika zvinhu, nezvimwewo)
• 2) Passive (zororo) atelectasis inoitika kana kusangana pakati parietal uye visceral pleura kukanganiswa (pleural effusion & pneumothorax)
• 3) Compressive atelectasis inoitika semugumisiro weiipi chero ipi zvayo inonzi thoracic-occupying lesion iri kukonzera mapapu uye ichimanikidza mweya kunze kweiyo
• 4) Chirwere chekudya atelectasis: chinoitika semugumisiro wekucheka kana fibrosis inoderedza kukura kwemapapu sezvinoita zvirwere zvakakura, necrotizing pneumonia, uye radiation fibrosis
• 5) Adhesive lung atelectasis inowanikwa kubva pakushaya simba uye kuparara kwemagetsi
• 6) Chipata-kana kana chinowanikwa kazhinji chinowanikwa mushure mekutevera anesthesia
• 7) Kufananidza zviitiko: kupera kwemapapu, kubuda kwemapapu emapapu, kupotsa kwemukatikati, kukwira kwechidimbu, kuwedzera kwemafupa emapapu asina kukodzera

 

 

• Mediastinum: hutachiona hunogona kugoverwa mune izvo zvinoguma nehukuru hwepamusoro kana izvo zvinokonzera zvirwere zvakasiyana zvinosanganisira mediastinum. Uyezve, mweya inogona kutarisa mukati me mediastinum mu pneumomediastinum. Zivo yehutachiona hwemuviri inobatsira Dx.
• Anterior masikati makuru: thyroid, thymus, teratoma / germ cell tumor, lymphoma, lymphadenopathy, achikwira anortic aneurysms
• Pakati pemasikati makuru: lymphadenopathy, vascular, bronchial lesions etc.
• Posterior mediastinal masses: neurogenic tumor, aneorysms aortic, esophageal masses, spinal masses, aortic chain adenopathy

 

 

• Pulmonary emphysema: kurasikirwa kwemazuva ose elastic tissue / kutengesa kwepapu nekuparadzwa kwemapapuriri uye sarumenolar septum / interstitium.
• Kuparadzwa kwemapapu parenchyma nekuda kwekusingaperi kukira. Protease-mediated destruction of elastin. Kushungurudza air / space space, kuwedzera, hyperinflation, pulmonary hypertension, uye zvimwe zvinoshanduka. Kliniki: progressive dyspnea, isingabvumirwi. Nenguva iyo iyo yakamanikidzirwa kuporesa mukati ye 1 yechipiri (FEV1) yakawira ku 50% murwere ari kufema paanenge achiita zvishoma uye anogadzirisa mararamiro.
• COPD ndiyo yechitatu inokonzera rufu rwepasi rose. Inobata 1.4% yevanhu vakuru muUnited States. M: F = 1: 0.9. Pts 45 makore uye kupfuura
• Zvinokonzera: Kusvuta uye-1-Antitrypsin kukwana (yakakamurwa kuva centrilobular (kusvuta) uye panacinar.
• Imaging; zviratidzo zve hyperinflation, air trapping, bullae, pulmonary hypertension.