Post on 04-Apr-2018
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Investigatii paraclinice de diagnostic
Imagistica
Radiologia clasica
CT
RMN
Examenul ultrasonografic
Scintigrama de ventilatie/perfuzie
- PET
- Angiografia
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CT
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RMN
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PET
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Scintigrama V/Q
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Investigatii paraclinice de diagnostic
Bronhoscopia
Patologie endobronsica
Biopsie broonsica si transbronsica
Lavaj bronhoalveolar (bronsie subsegmentara)
Terapeutica (corpi straini,aspirarea
secretiilor,hemoptizia)
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Investigatii pentru diagnosticul
morfologic
Examen citologic
Sputa
Aspirat si lavaj bronsic
Lavaj bronhoalveolar
Ex lichidului pleural
Examen histopatologic
Biopsia bronsica sau transbronsica
Biopsia percutana cu ac fin
Biopsia prin mediastinoscopie
Biopsia pulmonara (toracotomie)
Biopsia pleurala
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Lavaj bronhoalveolar
Modificari pulmonare interstitiale sau infiltrate nesistematizate
Particole de pulberi in macrofage pneumoconioze
Fragmente de eritrocite
sd de hemoragie intraalveolara
Infectii cu germeni oportunisti
Cel tumorale cancer pulmonar, limfoame
Limfocitoza cu raport CD4/CD8, eozinofilie
Colagenoze, limfoame
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Evaluarea ventilatiei
Volume, capacitati
Complianta pulmonara (statica)
Crescuta emfizem
Scazuta
fibroza interstitiala
perete toracic (cifoscolioza, obezitate)
Forta musculaturii respiratorii
Presiunea maxima inspiratorie/expiratorie
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Volume si capacitati
Evaluarea ventilatiei
Probe ventilatorii (Conditii dinamice = Spirometrie)
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VEMS (valoare absoluta) sau VEMS/CV (%)
Debit maximal la mijlocul expiratiei (Forced midexpiratory flow rate)
VEMS scazut (valoare absoluta) sau VEMS/CV (%)Curba aplatizataDurata expirului mai mareVolumele/capacitatea pulmonare crescute
CV si CVF scazute ; VEMS/CV (%)Volumele/capacitatile pulmonare scazute
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Normal
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Restrictie
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Obstructie
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Obstructie
VEMS/CVF scazut
Volumele pulmonare
crescute (VR, CRF, CPT)
Restrictie
CV scazuta
VEMS/CVF normal
Volumele pulmonare
scazute
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Factorul de transfer gazosCapacitatea de difuziune a CO (DLCO)
DLCO = Aria (membr. alv.-capilare) X Pco / Grosimea ( membr. alv.-capilare)
DLCO scazut
-emfizem,
- boli restrictive,
- pneumectomie
- HTAP
- anemie
DLCO crescut - policitemie, efort, sunturi stanga-dreapta, obezitate