Faamaʻi O Le Auala Taʻi Fata I Ata Diagnostic Imaging

Core Anatomy

• Matau augatupulaga o le tracheal-bronchial Tree, lobes, vaega, ma femalagaaʻiga. Faʻaaliga lona lua pulmonary lobule (1.5-2-cm) -o le autu aoga iunite o mama matauina luga HRCT. Manatua faʻatulagaina taua faʻatulagaina o alveolar avanoa ma fesoʻotaʻiga i le va o (pores o Kohn & alavai o Lambert) e faʻatagaina ai le tafetafea o le ea ma i le tutusa auala faʻatagaina faʻalautele suavai exudative poʻo transudative e sosolo atu i le māmā ma taofi i le vaelua. Manatua le anatomy o le pleura: parietal o se vaega o le endothoracic fascia ma le visceral e fausia ai se mama i luma pleura avanoa i le va.

 

 

• Mediastinum: siosiomia e le tagi ma le pala. Faʻaaoga nofoaga tetele e aofia ai tele lymph nodes (silasila i le faʻataʻitaʻiga o nusipepa ma le latou auai i Lymphoma

 

 

Avanoa Lautele i le Suʻesuʻeina o Talosaga

• Telefoni feaveaʻi (Chest X-ray CXR); sili atu 1st laasaga. Tau maualalo, maualalo o le faʻavelaina o le radiation, suʻesuʻega o faitioga e tele
• CT numera: CT C, High Resolution CT (HRCT)
• Faʻailoga o togafitiga o fata:
• Tigā
• Faʻafitauli
• Neoplasms
• O le edema palapone
• Pulmonary emphysema
• Atelectasis
• Faʻafitauli faʻapitoa
• Mediastinum

PA & Faʻatonu CXR

 

• E mafai ona faʻaopopo manatu faaopoopo:
• Manatu faʻapitoa: fesoasoani e iloilo vailaau faʻapitoa
• Tusitusia taumatau i le taumatau ma le agavale: fesoasoani e iloilo vailaau faʻasalaga maaleale, pneumothorax ma isi togafiti

 

 

 

• Masani CXR PA & Faʻamatalaga lautele. Faʻamautinoa lelei le faʻaalia: T-spine discs ma vaʻa ala i le fatu o loʻo vaʻaia i le PA vaʻaiga. Faitau le 9-10 taumatau ivi aso i tua e faʻamaonia ai taumafaiga lava faʻamalosia. Amata se suʻesuʻega maeʻaeʻa faʻaaoga le auala lea: E I Ai Tele Losi Lesona A-manava / diaphragm, T-thorax pa, M-mediastinum, L-mama tasi, Lua-uma. Atiina ae se lelei suʻesuʻega faʻataʻitaʻiga

 

 

• 1) Faʻamaʻi Airspace aka faʻamaʻi alveolar baga? Faʻatumuina o alveoli o le māmā, acini ma mulimuli ane ai le lobe atoa i suavai poʻo vailaʻau o soʻo se vaega (toto, nana, vai, proteinaceous mea poʻo sela foi) Radiographically: lobar poʻo vaevaega tufatufaina, airspace nodules mafai ona maitauina, agaʻi i le coalesce, ea bronchograms ma silhouette sign o loʻo iai. Batwing (butterfly) tufatufaina maitauina pei i le (CHF). Suʻesuʻe vave ile taimi, ie, faʻateleina pe faʻaititia (aso)
• 2) Faʻalavelave faʻafuaseʻi: ulufale i totonu o le pulmonary interstitium (alveoli septum, lung parenchyma, vaʻa o vaʻa, ma isi) e ala i faʻataʻitaʻiga e siama, tamaʻi siama, vailaʻau. Faʻapipiʻiina foʻi sela e pei o sela mumu / faʻamaʻi (eg, lymphocytes) Faʻaalia o se faʻamamafaina o le sela interstitium ma le reticular, nodular, feololo faʻatasi mamanu retulitonodular. Etiologies 'eseʻese: afaina afaina o le autoimmune, faʻamaʻi o le māmā i le fiva, faʻamaʻi o le mama i galuega, faʻamaʻi viral / mycoplasma, TB, sarcoidosis lymphoma / leukemia ma le tele o isi.

 

 

• O le iloaina o faʻavae eseʻese o faʻamaʻi mama e mafai ona fesoasoani i le DDx. Misasa vs. tuʻufaʻatasia (agavale). Faʻailoa eseesega o faʻamaʻi o le pulmonary: faʻamaʻi o le malae vaʻalele e pei o le faʻamautuina o le palakalafa o le niumonia, faʻalauteleina o le tuʻufaʻatasia o faʻamaoniga o le edema pulmonary. Atelectasis (paʻu ma leiloa leiloa). Mamanu feololo o faamaʻi o le mama: reticular, nodular pe fefiloi. SPN vs. Multiple focal consolidations (nodules) e fai ma sui o mets infiltrates vs. septic infiltrates

 

 

• A = le totogia
• B = paʻu
• C = faaopoopo faaopoopo
• Ia iloa le mea taua o lupe

 

 

• Faailoga taua: Faailoilo Silhouette: fesoasoani i localization ma DDx. Faataitaiga: Lalo pito tauagavale: leitio i totonu o le manava saʻo, o fea o iai? Taumatau MM ona o le saʻo saʻo o le fatu e latalata i le vaeluagalemu o le vavalalata e le o vaaia (silhouetted) Airchograms o le ea: ea o loʻo i ai bronchi / bronchioles o loʻo siomia e le suavai

 

 

Chet Trauma

• Pneumothorax (PTX): ea (kesi) i le avanoa lautele. Tele mafuaaga. Faʻafitauli:
• Tension PTX: faʻaauauina le maualuga o le ea i totonu o le vateatea lea e faʻavavevave ona faʻamalosi le mediastinum ma le tino e vave faʻaitiitia ai le toe foi mai o le fatu i le fatu. E ono afaina pe a le togafitia vave
• Faʻafuaseʻi PTX: muamua (talavou matutua (30 -40) faʻapitoa aliʻi, manifinifi aliʻi. Mafuaʻaga mafuaʻaga: Marfan s syndrome, EDS, Homocystinuria, a - 1 -antitrypsin le lava. Lona lua: matutua pts ma parenchymal faʻamaʻi: neoplasms, abscess, empysema , māmā fibrosis ma honeycombing, catamenial PTX d / t endometriosis ma isi.
• Traumatic pneumothorax: mama laceration, tuʻusaʻo manuʻa, iatrogenic (pusa o le pusa, ma isi) acupunkure, ma isi
• CXR: tusi visceral pleura laina aka lung edge. O le toesea o pulmonary pepa solo / vaʻa i tala atu o le visceral pleural line. E mafai ona misia le paʻu o le pneumothorax. I luga o le tulaga faʻatuina, ea ea ma PTX e tatau ona sailia i le pito i luga.
• Ivi ivi asoaso: v. Masani. Faʻalavelave pe faʻasolosolo (eg, mets, MM) Rib series x - ave e le aoga tele ona ole CXR ma / poʻo le CT scanning e sili atu le taua e iloilo ai posttraumatic PTX (lalo agavale) māmā laceration ma se isi auala tele

 

 

Faʻafitauli

• Pomonia: siama vs. viral poʻo fungal poʻo i le fale talimalo puipuia (eg, Cryptococcus i le HIV / AIDS) Pulmonary TB

 

 

• Pomaonia: faʻaleaganuʻu-mauaina vs. falemai-maua. Faʻasologa o le pneumonia ma le Lobar (e le o se vaega) o le niumonia ma le purulent mea e faʻatumu ai le alveoli ma faʻasalalau i le vavao atoa. M / C organismStreptococcus Pneumonia poʻo le Pneumococcus
• Isi: (Staph, Pseudomonas, Klebsiella esp. I tagata inu ava malosi e ono taitai atu ai i le neroSIS / pulupulu gangrene) Mycoplasma (20-30s) aka savavali niumonia, ma isi.
• Falemaʻi: o le gaosiga o le tale, fiva, paʻu o le fagu paʻu i nisi o taimi.
• CXR: faʻalavelave faʻapitoa vaalele i luga o le vaalele e faʻatapulaʻaina i le vavao atoa. Mala uila. Faailoga silhouette fesoasoani i le nofoaga.
• Viral: Influenza, VZV, HSV, EBV, RSV, ma isi mea o loʻo avea ma faʻamaʻi o le mama i le va o tagata e mafai ona lua felavasaʻi. E ono taitai atu ai i le manava fetuunai
• Atypical pneumonia ma Fungal Pneumonia: Mycoplasma, faʻamaʻi o Legionnaire, ma nisi fungal / Cryptococcus pneumonia e ono iai faʻamaʻi pipisi i totonu.
• Pulmonary abscess: o se faʻamaʻi pipisi o purulent mea i totonu o mama e masani ona necrotize. E ono taitai atu ai i le taua pulmonary ma faiga faʻalavelave / faʻafefe ola.
• I luga o le CXR poʻo le CT: faʻasologa o lapotopoto ma ni vaʻaiga mafiafia ma le necrosis tutotonu o loʻo i ai le maualuga o le ea. DDx mai le faʻapipiʻi e faʻasaʻo ai le tino ma le totoga
• Rx: antibiotic, antifungal, agents antiviral.
• O le niumonia e tatau ona mulimulitaia ma toe fai CXR e faʻamautinoa le atoatoa o le iugafono
• Le tele o le faʻalauiloaina o le eletise o le niumonia e ono faʻaalia ai le teenaina o le puipuiga, faʻamalositisi o siama, siakiina o le toto ma le isi mea faʻamalosia

TB Pulmonary

 

• Faiga masani masani i le lalolagi atoa (3rd atunuu o le lalolagi). 1 i 3 tagata i le lalolagi atoa e aafia i le TB. TB e mafua mai i Mycobacterium TB poʻo Mycobacterium Bovis. Intracellular bacillus. O Macrophage e tāua se vaega taua.
• Tulaga Mama o le Mumu TB & Post-muamua TB. Manaʻomia le toe faʻailoaina e ala i le manava. I le tele o talimalo talimalo, o le faʻamaʻi pipisi e le tupuola
• TB e pei o 1) faʻamamaina e le 'auʻaunaga, 2) faʻamalosi i le Latent Tuberculosis Infection (LTBI) 3) mafua ai le maʻi TB. O tagata maʻi faʻatasi ma le LTBI latou te le faasalalauina le TB.
• Ata: CXR, HRCT. Tulaga muamua TB: pulmonary airspace consolidation (60%) pito i lalo maualalo, lymphadenopathy (95% - hilar & paratracheal), pleural effusion (10%). Le Faʻasalalau o le muamua TB e foliga mai e puipuia ile faʻamalosiʻau ma tamaiti.
• Milliary TB: pulmonary ma le faʻalauteleina o faʻalapotopotoga faʻasalalau e mafai ona afaina
• Post-primary (secondary) poʻo le faʻafouina o le faʻafouina o tino: O le tele lava i totonu o Apices ma pito i tua o le pito i luga) maualuga le PO2), 40% -o le faʻamalosia o leona, maʻi poʻo le faʻalavelave faʻamaʻi vaalele, fibrocalcific. Faʻaputuga Latent: faʻamatalaga nodal.
• Dx: Ava-fast bacilli (AFB) smear ma aganuu (sputum). Vailaʻau HIV i tagata uma e maua i le TB ma le le iloa le HIV
• Rx: 4 fualaau faʻatau: isoniazid, rifampin, pyrazinamide, ma le ethambutol poʻo le streptomycin.

Neoplasms o le Pulmonary (o le tino o le kanesa o le tino ma le metastase pulmonary)

• Kanesa o le susu: m / c o le kanesa i tane ma le 6th o le tele o le kanesa i tamaitai. Malosiaga malolosi ma le faʻamaʻiina o le tino. Falemaʻi: tuai ona maua, e faalagolago i le nofoaga o le paʻu. Fomaʻi (ituaiga): Tamaititi laititi (SCC) ma
• Laititi laitiiti: (20%) e atiae mai le neuroendocrine ma le Kultchitsky cell, ma mafai ai ona faʻamalosi mea o loʻo faʻaalia i le biologically presenting with a paraneoplastic syndrome. O le mea e masani ona maua i totonu (95%) i le latalata i le masini autu / lobar bronchus. O le toʻatele e sili atu ona faʻaalia le leaga o le faʻasolosolo ma e le mafaamatalaina.
• Laititi e le o se tamai: Alumini o le tino (40%) (M / C cancer), M / C i fafine ma tagata e le ulaula tapaa. Isi: Televave masima (atonu o iai ma le vevela), Fale tele ma isi
• Laugatasi ata tifaga (CXR): fou pe faʻateleina faʻapitoa laʻau, faʻalauteleina mediastinum fautua mai o le lymph node aofia ai, pleural effusion, atelectasis, ma le tuʻufaʻatasia. SPN-atonu e faʻaalia ai ono maua i le kanesa kanesa aemaise lava pe a iai ni faʻaletonu faʻafitauli, fafagaina vaʻa, mafiafia pa, i le pito i luga mama. Tele nodules mama e ono avea ma sui metastasis.
• Lelei sili ona lelei: HRCT faʻatasi.
• Isi pusa o le pusa: Lymphoma e vatele i totonu o le fatafata aemaise lava i faʻamatalaga tusitusia ma mammary.
• Ole aofaʻiga ole M / C pulmonary neoplasms ose metastasis. O nisi faʻamaʻi e faʻaalia ai le maualuga o le faʻavaʻa mo mama, pei o Melanoma, ae o soʻo se kanesa e mafai ona faʻasolosolo i māmā. Nisi mets taʻua o le "Canneball" metastasis
• Rx: radiation, chemotherapy, resection

 

 

• O le edema o le pulmonary: o se faaupuga lautele e faʻamatalaina ai le faʻaputuputuga o le suavai le masani ai i fafo atu o faʻavae o le tino. Lautele vaevaeina i Cardiogenic (eg, CHF, mitral regurgitation) ma Non-cardiogenic ma le tele o mafuaʻaga (eg, suavai soona, post-transfusion, neura mafuaʻaga, ARDS, latalata malemo / asphyxiation, heroin overdose, ma isi)
• Mafuaaga: faʻalauteleina i le malosi o le vai ma vs faʻaititia i luga o le mamafa o le oncotic.
• Ata: CXR ma CT: 2-ituaiga Interstitial ma Alveolar lologa. Faʻataʻitaʻiga ata e faalagolago i laʻasaga
• I le CHF: Vaega 1: toe tufatufaina o vaʻa tafe (10- 18-mm Hg) taʻua o le `` faʻamamafaina '' o le pulmonary vasculature. Vaega 2: Faʻamatalaga vaeluaina (18-25-mm Hg) Faʻamatalaga o loʻo vaeluaina: peribronchial cuffing, Kerley laina (lymphatics tumu i suavai) A, B, C laina. Vaega 3: Alveolar edema: airspace faamaʻi: faʻapipiʻi faʻapipiʻi o loʻo tupu ae i faʻamaʻi vaʻai vaʻalele: Batwing edema, air bronchograms
• Rx: 3 autu autu: Muamua O2 ia tausia O2 i le 90% saturation
• Sosoo ai: (1) faʻaititia o pulmonary venous return (preload faʻaititia), (2) faʻaititia o systemic vascular tetee (afterload faʻaititia), ma le (3) inotropic lagolago. Togafitiga mafuaʻaga mafuaʻaga (eg, CHF)

 

 

• O le ate atelectasis: faʻalauteleina le faʻalauteleina o pulmonary parenchyma. O le upu "paʻu māmā" e masani lava ona faʻasao pe a paʻu atoa le mama
• 1) Resorptive (faʻalavelave) atelectasis tupu o se faʻaiuga o le atoa poloka o se auala ea (eg tumo, manava mea, ma isi)
• 2) Passive (malologa) atelectasis tupu pe a faʻafesoʻotaʻi le va o le parietal ma visceral pleura ua faʻalavelaveina (pleural effusion & pneumothorax)
• 3) Faʻaleagaina le atelectasis e tupu mai ona o soʻo se vailaʻau vaʻaiga-o loʻo nofoia le liona e faʻapipiʻi ai le toto ma faamalosia ai fafo mai le alveoli
• 4) Cicatricial atelectasis: tupu o se faʻaiuga o maʻila poʻo fibrosis e faʻaititia ai le faʻalauteleina o le mama e pei o maʻamaʻi granulomatous, nerotizing niumonia, ma radiation fibrosis
• 5) O le ate elemene o le pulupulu e tupu mai i le tuai o le tuai ma le paʻu o le alveolar
• 6) E masani lava ona atiaʻe le faʻatalanoaga poʻo le mea e masani ai pe a uma ona mulimulitaʻi i le faʻalapotopotoga lautele
• 7) Ata faʻataʻitaʻi: paʻu o le mama, femalagaaiga o ponaivi o le māmā, feseʻeseaʻiga o le mediastinum, siʻi aʻe o le diaphragm, hyperinflation o faʻataʻamilosaga mama le afaina

 

 

• Mediastinum: faʻasologa o togafitiga e mafai ona vaevaeina ia i latou e mafua ai le maualuga o le mamafa poʻo i latou e mafua ai le faasalalauina o faʻamaʻi e aofia ai le mediastinum. E le gata i lea, o le ea e mafai ona vaʻai i totonu o le mediastinum i le pneumomediastinum. O le malamalama i le faʻalauiloaina o le tino e fesoasoani i le Dx.
• Manatu pito i luga o le mediastinal: lauroid, musika, teratoma / germ cell tumors, lymphoma, lymphadenopathy, oso aʻe aisicys aortic
• Maualuluga mediastinal masses: lymphadenopathy, vascular, bronchial lions etc.
• Faʻalauiloa pito i luga o le mediastinal: tima neurogenic, vaʻaia aisiki, tino o le esophage, faʻalaʻau o le fatulaʻau, faʻasalaga faʻasolosolo

 

 

• Pulmonary empysema: leiloa o normal eletise / eletise toe faʻamamaina o le māmā ma le faʻatamaiaina o capillaries ma alveolar septum / interstitium.
• Faʻaleagaina o pachyyma o le tino ona o le mumū masani. Puipuiga-faʻasalalau faʻasalalau o le elastin. Faʻaleleia o le ea / ea, hyperinflation, maualuga o le pulmonary, ma isi suiga. Falemaʻi: o le dyspnea alualu i luma, e le mafai ona suia. E oʻo ane i le taimi na faʻauluina ai le numera o le expiratory voltage i le 1 lua (FEV1) i le 50% o le tagata maʻi e le manava i luga o le galue malosi ma e fetaui ma olaga soifua.
• O le COPD o le mafuaaga lona tolu o le oti i le lalolagi. E aafia ai le 1.4% o tagata matutua i le US. M: F = 1: 0.9. Pts 45 tausaga ma le matua
• Faʻaiʻuga: Leʻa ulaula ma le-1-Antitrypsin le lava (vaevaeina i centrilobular (ulaula) ma panacinar.
• Ata; faailoilo o le hyperinflation, felaʻi i luga o le ea, pullae, maualuga o le toto.