Curs 5 CORD Patologie
Transcript of Curs 5 CORD Patologie
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CATEDRA DE RADIOLOGIE UMF Cluj-Napoca
EXAMINAREA RADIO – IMAGISTICAA CORDULUI
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Semiologie radiologica Semiologie radiologica cardio-vascularacardio-vasculara
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Aprecierea maririi cavitatilor cardiaceAprecierea maririi cavitatilor cardiace
• Gradul I usor marit• Gradul II marit• Gradul III mult marit
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Gradele de marire ale atriului Gradele de marire ale atriului stang / conturul drept inferior PAstang / conturul drept inferior PA
b. Gradul I – dublu contur concentricc. Gradul II – dublu contur excentricd. Gradul III – arc inferior, AS nu ajunge la diafragm
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Masurarea atriului stang - PAMasurarea atriului stang - PA
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Semiologie - marirea ASSemiologie - marirea AS
• PA– conturul inferior drept al inimii– urechiusa stanga– diametrul transvers– orizontalizarea bronhiei stg.– unghiul bifurcatiei traheei > 75 0
– Hipertensiune venoasa pulm.
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AS gradul I
Semiologie - marirea AS - PASemiologie - marirea AS - PA
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AS gradul I
Semiologie - marirea AS - PASemiologie - marirea AS - PA
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Semiologie - marirea AS - PASemiologie - marirea AS - PA
Gradul II
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Semiologie - marirea AS - PASemiologie - marirea AS - PA
Gradul II
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Semiologie - marirea AS - PASemiologie - marirea AS - PA
Gradul III
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Semiologie - marirea AS - PASemiologie - marirea AS - PA
Gradul III
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Masurarea atriului stang in TSMasurarea atriului stang in TS
= <40 mm = <36 mm
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Semiologie - marirea ASSemiologie - marirea ASOAD - amprenta pe esofag
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• Dg. pozitiv (calitativ)– OAD– PA
• Dg. de severitate (cantitativ)– PA
Semiologie - marirea AS Semiologie - marirea AS
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a. PA - bombarea arcului inferior dreptb. OAS - bombarea arcului antero-superior
Semiologie - marirea ADSemiologie - marirea AD
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Semiologie - marirea AD - PASemiologie - marirea AD - PA
PA contur inferior dreptPA contur inferior drept
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Semiologie – marirea VS - PASemiologie – marirea VS - PA
Marirea VS in PA - arc inferior stang bombat > ½ diafragmA. predominanta dilatatieiB. predominanta hipertrofiei
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Semiologie – marirea VSSemiologie – marirea VS
Marirea VS in PA
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TS - Metoda Hoffmann–Riegler modificări incipiente a VS
Semiologie TS – marire incipienta a Semiologie TS – marire incipienta a VSVS
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• Dg. pozitiv (calitativ) :– PA– TS– OAS
• Dg. de severitate (cantitativ) :– TS (mariri incipiente, mici)– OAS
Semiologie - marirea VS Semiologie - marirea VS
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Semiologie - mSemiologie - mărirea VDărirea VD
PA – ridica apexul, “coeur en sabot”, bombarea TAP LL - ocuparea spaţiului retrosternal până la dispariţia luiOAS – reducerea spaţiului retrosternal OAD – conul pulmonarei şi VD bombează anterior
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Semiologie - mSemiologie - mărirea VDărirea VD
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Semiologie - AortaSemiologie - Aorta
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Semiologie - aortaSemiologie - aorta
Metoda Kreuzfuchs
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Semiologie - AortaSemiologie - Aorta
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Masurarea arterei pulmonareMasurarea arterei pulmonare
= <16 mm
= <15 mm
Valori normale ale indiceluiArterio-bronsic (Woytowicz)
PA – arcul II 2/3 sup
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ValvulopatiiValvulopatii
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VALVULOPATII / Metode
Radiografia Radioscopia/ fluoroscopia Ecografia transtoracica ETE Cateterism cardiac IRM CT
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Valvulopatii / Stenoza mitralaValvulopatii / Stenoza mitrala= micsorarea orificiului mitral- etiologie : boala reumatica cauze obstructive AV ( tromb, tumora, mixom)- M:F = 1:8- patogeneza: dilatare AS hipertensiune venoasa pulmonara hipertensiune pulmonara mixta hipertrofie VD insuficienta tricuspidiana insufucienta cardiaca dreapta
Modificari radio-imagistice corelate
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Valvulopatii / Stenoza mitralaValvulopatii / Stenoza mitrala
- marire AS + urechiusa - incarcarea circulatiei pulmonare
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Valvulopatii / Stenoza mitrala
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Valvulopatii / Insuficienta mitralaValvulopatii / Insuficienta mitrala
= valva mitrala incontinenta- organica – leziuni – reumatice, degenerative, infectioase, ischemice, congenitale, traumatice- functionala – secundar dilatarii VS- patogeneza: marire AS si VS + consecintele hemodinamice
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Valvulopatii / Insuficienta mitralaValvulopatii / Insuficienta mitrala
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Valvulopatii / Insuficienta mitralaValvulopatii / Insuficienta mitrala
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Valvulopatii / Insuficienta aorticaValvulopatii / Insuficienta aortica
= inchidere incompleta a valvulelor sigmoide aortice in diastola
- patogeneza : hipertrofiere si dilatare a VS
- marirea VS ( PA si OAS)- largirea AO, buton Ao proeminent- arc mijlociu concav
Ecocord: + regurgitare
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Valvulopatii / cord aortic
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Valvulopatii / stenoza aortica
= micsorarea orificiului aortic
- patogeneza : cantitate mica de sange in sistola in aorta incipient – hipertrofie Vs apoi dilatare VS cresterea presiunii jetului VS- Ao dilatatie poststenotica
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Mase intracardiaceMase intracardiace
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Aspectul cordului in afectiunile Aspectul cordului in afectiunile miocardicemiocardice
= afectare a miocardului de origine ischemica, dismetabolica - marire globala a cordului, toate cavitatile - modificarea formei cordului- “ culcat pe diafragm” - imobilitatea formei cordului in manevre speciale - pulsatii cardiace prezente, dar mici - semne ale afectiunii de baza ; HTA, ATS - +/- semne de insuficienta cardiaca
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Aspectul cordului in afectiunile Aspectul cordului in afectiunile pericarduluipericardului
= afectare a pericardului : colectie ingrosare fibroasa ingrosare calcara ingrosare tumorala
- modificarea dimensiunilor cordului - mare ( colectie - tumora) - mica (peric . constrictiva) - modificarea formei cordului – disparitia arcurilor cardiace- imobilitatea formei cordului in manevre speciale- pulsatii cardiace absente / reduse- semne ale afectiunii de baza - +/- semne de insuficienta cardiaca
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Aspectul cordului in afectiuni Aspectul cordului in afectiuni pericardice si miocardicepericardice si miocardice
Pericardita Miocardita
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Aspectul cordului in afectiuni Aspectul cordului in afectiuni pericardice si miocardicepericardice si miocardice
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Pericardita cronicaPericardita cronica• Constrictiva
– simfiza foitelor pericardice cu calcifieri– pulsatii amplitudine mica – impiedica diastola– determina staza anterograda
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Pericardita cronicaPericardita cronica
• Adeziva, neconstrictiva (mediastinopericardita adeziva)
- simfiza foitei parietale a peric.
cu pleura mediastinala si
fascia endotoracica
- tractiuni ale diafragmelor si
sternului
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Calcifieri pericardiceCalcifieri pericardice
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Pericardita constirictiva
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Cine-MRI Cine-MRI Cine-MRI
Pericardita cronica39 ani; 30 ani dupa radioterapie
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