ευρήματα από την HRCT 2

περιεχόμενα |εισαγωγή|γραμμικές και δικτυώδεις σκιάσεις|σημείο διαμετωπίσεως|περιβρογχαγγειακή διάμεση πάχυνση|πάχυνση ενδολοβιδιακών διαφραγματίων|παρεχγυματικές ταινίες|πάχυνση υποπλεύριου διάμεσου ιστού|πάχυνση ενδολόβιου διάμεσου ιστού|μελιττοκηρύθρα|ανώμαλες γραμμικές σκιάσεις|υποπλεύριες γραμμές|οζώδεις και οζιδιακές σκιάσεις|βιβλιογραφία||||||
εισαγωγή
Η αναγνώριση παρεγχυματικών διαταραχών με τη βοήθεια της αξονικής τομογραφίας υψηλής διακριτικότητας εξαρτάται από τον εντοπισμό συγκεκριμένων παθολογικών ευρημάτων (1,2,3,4). Γενικά, τα ευρήματα σε μια 'παθολογική' αξονική τομογραφία -όπως, εξάλλου, και στην απλή ακτινογραφία θώρακος-υψηλής αναλύσεως εμπίτουν στις εξής 4 κατηγορίες:
γραμμικές και δικτυώδεις σκιάσεις
α. όζοι και οζίδια
β. ευρήματα αυξημένης ακτινολογικής πυκνότητας και,
γ. ευρήματα μειωμένης ακτινολογικής πυκνότητας, στα οποία περιλαμβάνονται κυστικές βλάβες, εμφύσημα, και διαταραχές αεραγωγών

	πύκνωση: υγρό ή εκκρίσεις, συγκεντρωμένες στις κυψελίδες. πνευμονία, πνευμονικό οίδημα ή πνευμονική αιμορραγία. ARDS, COP, λέμφωμα, φαρμακοεπάγωγε πνευμονοπάθειες, βρογχοκυψελιδικό καρκίνωμα, ηωσινοφιλική πνευμονία
	πύκνωση:
	παγίδευση αέρος: μερική απόφραξη μικρών αεραγωγών. άσθμα, συγκλειστική βρογχιολίτις, ΧΑΠ
	κυστικοί αεροχώροι. σαφώς αφοριζόμενοι αεροπληθείς χώροι, με ορισμένο τοίχωμα. Λεμφαγγειολυομυομάτωση, ιστιοκύτωση Langerhans, τελικού σταδίου συνήθης διάμεση πνευμονία, PCP, LIP, σηπτικά έμβολα. Tα τοιχώματα είναι λεπτά, ανώμαλα, και διασπείρονται ευρύτερα, συγκριτικά με τους αεροχώρους επί πνευμονικού εμφυσήματος.
	περιφερικές κύστεις, εικόνα μελιττοκηρύθρας, επί συνήθους διάμεσης πνευμονίας. Χαρακτηριστικά, συρρέουν υποπλευρίως.
	διερυσμένοι αεροχώροι επί πνευμονικού εμφυσήματος. Όχι πραγματικά τοιχώματα.
	κατά μήκος των σχισμών, βρογχαγγειακών ελύτρων και υποπλεύρια οζώδης απεικόνιση. Σαρκοείδωση, σάρκωμα Kaposi
	σαρκοείδωση. υποπλεύρια οζίδια
	ανώμαλες, οζώδεις παχύνσεις των σχισμών και των βρογχαγγειακών ελύτρων
	σκιάσεις θαμβής υάλου. γκριζωπή απεικόνιση του πνεύμονος. διάμεσος χώρος. Ο αέρας στους βρόγχους φαίνεται πιό μαύρος. Πνευμονικές φλεγμονωδεις καταστάσεις. Σαρκοείδωση, κυψλιδίτις, πώριμες εικόνες επί συνήθους διάμεσης πνευμονίας, άλλες διάμεσες πνευμονοπάθειες, πνευμονία εξ υπερευαισθησίας, πνευμονικό οίδημα, κυψελιδική αιμορραγία. κυψελιδική πρωτεΐνωση, φαρμακοεπάγωγες πνευμονοπάθειες, μετακτινική ίνωση
	εικόνα θαμβής υάλου, επί περιπτώσεως συνήθους διπαμεσης πνευμονίας, Αναγνωρίζονται μελιτοκηρύθρα και εξ έλξεως βογχεκτασίες.
	εικόνα μελιττοκηρύθρας, επί περιπτωσεως συνήθους διάμεσης πνευμονίας. Συνήθως, αναγνωρίζεται περιφερικά.
	σταθερότερες βλάβες μελιττοκηρύθρας, στην πνευμονική περιφέρεια, μιας περιπτώσεως συνήθους διάμεσης πνευμονίας. Παρατηρούνται εξ έλξεως βρογχεκτασίες που οφείλονται σε ίνωση του περιβάλλοντος πνευμονικού παρεγχύματος, καθώς επίσης και το δικτυακό πρότυπο που περιγράφει τα όρια των δευτερογενών πνευμονικών λοβιδίων.
	εικόνα μωσαϊκού. Καλώς αφοριζόμενες περιοχές φυσιολογικού πνεύμονος που περιβάλλουν παθολογικές περιοχές εμφανίζοντας το πρότυπο του 'μωσαϊκού'. Είναι ενδεικτικό νόσου των μικρών αεραγωγών, όπως είναι το άσθμα, οι αγγειακές παθήσεις, όπως η πνευμονική εμβολή ή διηθητικών πνευμονοπαθειών, όπως η συγκλειστική βρογχιολίτιδα, η πνευμονία εξ υπερευαιθησίας.
	μη ειδική διάμεση πνευμονίτις, που δείχνει εμβαλωματικό και μωσαϊκό πρότυπο, ενισχύσεως της ακτινολογικής πυκνότητας.
	πολλαπλά οζίδια, διαφορετικής διαμέτρου, που οφείλονται σε μετάσταση.
	Σαρκοείδωση. Πολλαπλά μικρά οζίδια καθ΄όλη την έκταση των πνευμόνων, που συνήθως, συνοδεύονται με άλλα ευρήματα επί σαρκοειδώσεως, όπως η οζώδης παραμόρφωση των σχισμών .
	ασθενώς αφοριζόμενα κεντροβοτρυδιακά οζίδια. Περιβρογχιολική φλεγμονή απουσία ενδαυλικών εκκρίσεων. Πνευμονία εξ υπερευαισθησίας, αναπνευστική βρογχιολίτις
	περίπτωση πνευμονίας εξ ευπερευαισθησίας. μαλακά οζίδια, στην πορεία του δευτερογενούς λοβιδίου.
	δικτυακό ή γραμμικό πρότυπο. Γραμμοεδείς λεπτές διαγραμμίσεις, ενδεικτικές παχύνσεως των μεσολοβιδίων διαφραγματίων. Διάμεσες πνευμονοπάθειες, όπως η συνήθης διάμεση πνευμονία, αμιάντωση, πνευμονικό οίδημα, φαρμακοεπάγωγη πνευμονική ίνωση, πνευμονική αιμορραγία, λεμφαγγειΐτις.
	πνευμονικό οίδημα, οφειλόμενο σε αριστερή καρδιακή ανεπάρκεια. διατεταμένα λόγω πληρώσεως λεμφαγγεία περιγράφουν το δευτερογενές λοβίδιο. Επιδείνωση στις εξαρτώμενες περιοχές (κατώτερες, λόγω βαρύτητας). Αμφοτερόπλευρη πλευριτική συλλογή και κατάληψη αεροχώρων, με πνευμονικό οίδημα
	εκτετεμένες εικόνες tree-in-bud, στον αριστερό κάτω λοβό, λόγω λοιμώξεως με ευκαιριακά μυκοβακηρίδια.

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