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Diagnostica per Immagini in pediatria
Gian Luigi NataliDipartimento delle Immagini
Ospedale Pediatrico “Bambino Gesù”, Roma
“Percorsi Decisionali per la gestione del bambinoe dell’adolescente”
Tabarka, 8-12 Luglio 2007
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LA FASE RESPIRATORIA
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NEONATO
INSP. ESP.
6 aa
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AUMENTO BILATERALE DEL CONTENUTO AEREO
• CAUSE NON OSTRUTTIVEinspirazione accentuata ***“fame d’aria” in acidosi ***“fame d’aria” cardiopatie cian. **• CAUSE OSTRUTTIVEinfezioni virali basse vie ***asma, fibrosi cistica **anelli vascolari *c. estranei tracheali, compressioni estr. *
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AUMENTO BILATERALE DEL CONTENUTO AEREO
La sovradistensionenon si realizza o è
diversa in una seconda
proiezione (es. laterale)
Inspirazione accentuata?
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AUMENTO BILATERALE DEL CONTENUTO AEREO
• Infezioni delle basse vie respiratorie (bronchiolite)
• Asma• F. cistica
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AUMENTO BILATERALE DEL CONTENUTO AEREO
• F. cistica
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AUMENTO BILATERALE DEL CONTENUTO AEREO
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RIDUZIONE BILATERALE DEL CONTENUTO AEREO
• inspirazione insufficiente ***• distensione addominale **
( masse, liquidi)• m. neuromuscolari *
( paralisi diaframmatica)• c. estranei -
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RIDUZIONE BILATERALE DEL CONTENUTO AEREO
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ASIMMETRIE DEL CONTENUTO AEREO
“quale è il lato patologico?”
RX INSPIRATORIO:il lato con vascolarità ridotta
RX INSPIRATORIO-ESPIRATORIOil lato che non si modifica o si modifica meno
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ASIMMETRIE DEL CONTENUTO AEREO
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EMITORACE IPERDIAFANO INGRANDITO
• enfisema ostruttivo ***• enfisema compensatorio ***• pneumotorace **• malattia polmonare cistica *• erniazione gastrica *
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EMITORACE IPERDIAFANO INGRANDITO
enfisema ostruttivo o compensatorio ?
Se ostruttivoil polmone rimane iperdiafano ed iperdisteso
sia in fase inspiratoria che espiratoria
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ENFISEMA OSTRUTTIVO
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EMITORACE IPERDIAFANO INGRANDITOPNEUMOTORACE NEONATALE
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EMITORACE IPERDIAFANO INGRANDITO
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EMITORACE IPERDIAFANO PICCOLO
• Ipoplasia polmonare **(ipoplasia arteria polmonare)• polmone di Swyer-James **(bronchiolite obliterante)• irradiazione *• embolia polmonare *
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EMITORACE OPACO INGRANDITO• Empiema ***• versamenti (linfoma) **• emotorace **• chilotorace *• pancreatite *• tumori torace *• ernia diaframmatica *
(priva di aria)
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EMITORACE OPACO INGRANDITOempiema
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EMITORACE OPACO INGRANDITO
?
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Ernia diaframmatica SN
2 m dopo intervento
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EMITORACE OPACO NON INGRANDITO
TORACE PICCOLO• atelettasia ***• agenesia polmonare *
TORACE DI NORMALI DIMENSIONI• versamento pleurico (paziente supino) **• addensamento di un intero polmone *
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EMITORACE OPACO NON INGRANDITO
• Atelettasia(tubo endo-tracheale)
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ARIA LIBERA• Pneumotoraceneonatale **traumatico **asma *rottura cisti p. o pneumatoceli *• pneumomediastinoasma **traumi, iatrogeno *• pneumopericardio *• pneumocardio *
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ARIA LIBERApneumotorace anteriore?
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ARIA LIBERApneumotorace?
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ARIA LIBERAPNEUMOMEDIASTINO
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Pneumotorace?
• Plica cutanea
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INFILTRATI POLMONARI
• ADDENSAMENTI LOBARI• OPACITA’ SFUMATE• OPACITA’ A STRIA• INFILTATI PERIBRONCHIALI-
PARAILARI• INFILTRATI RETICOLARI E NODULARI• OPACITA’ MILIARI
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ADDENSAMENTI LOBARI
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POLMONITE “A PALLA”
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OPACITA’ SFUMATE
• Infettive• Micotiche• Aspirazione• Emorragia polm.• Polmonite
uremica
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INFILTRATI PARAILARI PERIBRONCHIALI
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INFILTRATI RETICOLARI E RETICOLO NODULARI
INTERESSAMENTO INTERSTIZIALE
• Edema polm. cardiogeno e non
• Virosi• Micosi
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INFILTRATI POLMONARI
addensamento o atelettasia ?
Le atelettasie pure tendono a risolversi rapidamente
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1)linea paratracheale
2)arco superiore
3)arco medio
4)arco inferiore sinistro
5)arco inferiore destro
6)linee paravertebrali
1
5
6 6
2
SALIENZE DEL PROFILO MEDIASTINICO
4
3
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Salienze del profilo mediastinico
• Vena azigos normale +++
• Linfonodi +++
• Aorta destroposta++
• Tumori ++
• Vena azigos dilatata +
1
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• Dilatazione aortica+++
• Ductus bumb del neonato +++
• Tumori o cisti +++
• Vena emiaziogosdilatata +
• Aneurismi (aorta e arteria polmonare) +
Salienze del profilo mediastinico
2
2
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• Timo +++• Appendice dell’atrio
sinistro +++• Trasposizione corretta
++• Anomalie di Ebstein
++
Salienze del profilo mediastinico
3
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• Ipertrofia ventricolo sinistro +++
• Ipertrofia ventricolo destro +++
• Tumori del cuore e pericardio –
Salienze del profilo mediastinico
4
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Salienze del profilo mediastinico
• Dilatazione atrio destro +++
• Timo ingrandito +
5
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• Aorta normale +++• Aorta dilatata ++• Versamento pleurico ++• Ascessi paraspinali +++• Fratture vertebrali con
ematoma +++• Tumori paravertebrali ++• Adenopatie ++
Salienze del profilo mediastinico
6
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Slargamento del mediastino superiore ( bilaterale)
• Timo +++• Adenopatie ++• Tumori mediastinici ++• Mediastinite +• Ematoma mediastinico +• Gozzo +• Megaesofago +
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Slargamento del mediastino superiore (monolaterale)
• Timo normale +++• Vena cava superiore (D)++• Aorta ascendente dilatata (D) ++• Aorta destroposta ( D) ++• Atelettasia del lobo superiore ( D) ++• Adenopatie (D o S) ++• Tumori mediastinici ( D o S) ++• Megaesofago ( D o S ) -/+
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