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εικόνα θαμβής υάλου - πύκνωση πνευμονικού παρεγχύματος

 Η πύκνωση των αεροχώρων και η εικόνα θαμβής υάλου είναι βασικά ευρήματα από την HRCT σε σειρά παθολογικών καταστάσεων |εικόνα θαμβής υάλου|. 

εικόνα θαμβής υάλου/ορυκτής υάλου

Η εικόνα θαμβής (ή ορυκτής) υάλου αναφέρεται σε νεφελοειδή επίταση της ακτινολογικής πυκνότητας περιοχής του πνευμονικού παρεγχύματος, που δεν αποκρύπτει τους υποκείμενους αγγειακούς σχηματισμούς. Εάν τα υποκείμενα αγγεία ασαφοποιούνται, τότε η βλάβη ονομάζεται "πύκνωση" (1,2). Η εικόνα θαμβής υάλου παράγεται από μορφολογικές διαταραχές, κάτω από το αναλυτικό όριο της HRCT και μπορεί να αντανακλά περιορισμένη πάχυνση του διάμεσου ιστού ή των κυψελιδικών τοιχωμάτων, την παρουσία υγρού ή κυττάρων εντός των κυψελιδικών αεροχώρων, ή αύξηση του αίματος εντός των κυψελιδικών τριχοειδών (3,4,5,6,7). Το εύρημα αυτό αναγνωρίζεται σε πολλές παθολογικές καταστάσεις, όπως εκείνες που εμφανίζονται με κυψελιδική κατάληψη με υγρό ή κύτταρα, ή περιορισμένη πνευμονική ίνωση, και είναι, επομένως, μη ειδική. Οξέα άιτια εικόνων θμαβής υάλου αναγνωρίζονται επί πνευμονικού οιδήματος πνευμονικής αιμορραγίας, ιογενούς πνευμονίας, διάχυτης κυψελιδικής βλάβης ή πνευμονίας εξ υπερευαισθησίας (εικόνα 2).

  εικόνα 2.Πρότυπο ενίσχυσης ακτινολογικής πυκνότητας, επί αξονικής τομογραφίας. (a) εμβαλωματικές περιοχές ενισχύσεως "θαμβής υάλου" αναγνωρίζεται επί ασθενούς με κυψελιδική αιμορραγία, δευτεροπαθούς σε πνευμονική αγγειΐτιδα επί κοκκιωματώσεως Wegener. Σημειώνεται ότι τα υποκείμενα αγγεία διαγράφονται ικανοποιητικά (αντίθετα, παρ΄ό,τι επί πυκνώσως).  (b) Στην εικόνα αυτή διακρίνονται ευρύτερες περιοχές με εικόνα θαμβής υάλου επί ασθενοιύς με πνευμονία εκ Pneumocystis carinii.

Το εύρημα αυτό είναι κύριο ακτινολογικό χαρακτηριστικό σε ασθενείς με πνευμονία εξ υπερευαισθησίας (εξωγενής αλλεργική κυψελιδίτιδα, οξεία διάμεση πνευμ΄νία, μη ειδική διάμεση πνευμονία, πνευμονία από πνευμονιοκύτις carinnii, και, επιπλέον, σαρκοείδωση, κυψελιδική πρωτεΐνωση και βροχοκυψελιδικό καρκίνωμα. Η συνύπαρξη εικόνας 'θαμβής υάλου και παχύνσεως των διαφραγματίων, καλούμενος 'ακατάστατο παλκόστρωτο (crazy paving) μη ειδικό εύρημα που συναντάται στην κυψελιδική πρωτεΐνωση, την υποξεία πνευμονική αιμορραγία, την ιογενή πνευμονία, και το πνευμονικό οίδημα. Εάν η εικόνα θαμβής υάλου συνοδεύεται με εξ έλεξεως βρογχεκτασίες ή άλλο εύρημα ινώσεως είναι πιθανό ότι αντιστοιχεί σε λεπτή διάμεση ίνωση.

παρεγχυματική πύκνωση

Παρεγχυμνατική πύκνωση αναγνωρίζεται συχνότερα σε ασθενείς με βακτηριακή πνευμονία, και, επίσης, συγκλειστική βρογχιολίτιδα-οργανούμενη πνευμονία, χρόνια ηωσινοφιλική πνευμονία (8). Παρεγχυματικές σκιάσεις εκτεινόμενες απόμ εικόνες θαμβής υάλου προς παρεγχυματική πύκνωση αναγνωρίζονται σε καταστάσεις, όπως με πνευμονικό οίδημα (3,9,10,11), ARDS, (12,13,14), υογενή πνευμ΄νια, φυματίωση, και μυκητίαση πνεύμονος, πνευμονία εξ ακτινοβολίας, έμφρακτο, και βρογχιολοκυψελιδικό καρκίνωμα (14,15,16,17,18,19). Τα κλινικά και ακτινολογικά ευρήματα, συνήθως, είναι επαρκή για την τεκμηρίωση των παθολογικών αυτών καταστάσεων. Εν τούτοις, σε επιλεγμένες περιπτώσεις Η HRCTμπρεί να εισφέρει στη διαχείριση παρόμοιων περιπτώσεων αναγνωρίζοντας παθολογικά ευρήματα, όπου η απλή ακτινογραφία θώρακος παραμένει φυσιολογική, ή σε περιπτώσεις όπου απαιτείται η διευκρίνιση συγχυτικών ακτινολογικών εικόνων, ή προκειμένου να αποκριθούμε για την έκταση της παθήσεως. Επ΄αυτο΄, η HRCT μπορεί να διαδραματίσει σημαντικό ρόλο στην αναγνώριση λοιμώξεων επί ανοσοκατεσταλμένων ασθενών.  

Εικόνα 2. χρόνια ηωσινοφιλική πνευμονία. Αναγνωρίζονται: [ι] υποπλεύρια πύκνωση αεροχώρων [ιι] εμβαλωματικές εικόνες θαμβής υάλου, [ιιι] γραμμξικές σκιάσεις, που συνήθως εμφανίζονται στη λύση τους, Όπως διακρίνεται, οι βλάβες αυτές, συρρέουν, συνήθως, στα άνω πνευμονικά πεδία.

βλεπε: πνευμονία εξ υπερευαισθησίας (αλλεργική εξωγενής κυψελιδίτις), ηωσινοφιλικές πνευμονοπάθειες (ιδιοπαθής πνευμονική ηωσηνοφιλία, οξεία και χρόνια ηωσινοφιλική πνευμονία, υπερηωσινοφιλικό σύνδρομο), σύνδρομο Churg-Strauss, βρογχοκεντρική κοκκιωμάτωση, συγκλειστική βρογχιολίτις-οργανούμενη πνευμονία, αναπνευστική βρογχιολίτις-διάμεση πνευμονοπάθεια, αποφολιδωτική διάμεση πνευμονία, οξεία διάμεση πνευμονία, μη ειδική ιδιοπαθής διάμεση πνευμονία,  κυψελιδική πρωτεΐνωση, λιποειδής πνευμονία, διάχυτη πνευμονία, πνευμονία από πνευμονοκύστι carinii, πνευμονία από κυτταρομεγαλοϊό, λοιπές ιογενείς πνευμονίες, πνευμονία από μυκόπλασμα, διάχυτη κυψελιδική αιμορραγία, σύνδρομο GoodPasture, ιδιοπαθής πνευμονική αιμοσιδήρωση, πνευμονικό οίδημα και ARDS.

 

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