Radio Imagistica Esofagului

Rad/Imag.
-Iasi-2003
Rad/Imag.-Iasi-2003
Metode radio- imagistice:
RadiograIie toracic F P:
- indicatii: corpi straini radioopaci, spatiul prevertebral, linii
mediastinale, nivel hidro-aeric mediastinal;
Examinarea cu substant de contrast:
- indicatii: evaluare Iunctionala si anatomica (lumen, perete);
- suspensie de sulIat de Bariu: contrast simplu, dublu
contrast;
- Iluoroscopie Iilme tintite;
- inregistrare 'cine/video; incidente OAD, OAS, F, P;
- contrast hidrosolubil: perIoratie, Iistula, post-operator
precoce;
RADIO-IMAGISTICA ESOFAGULUI
Rad/Imag.-Iasi-2003
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ESOFAG BARITAT: ASPECTE NORMALE
a)-plenitudine,cardia deschisa,trece Bariu in
stomac;b).c)cardia inchisa;d)e)-dublu
contrast,strat subtire parietal de Bariu si aer in
lumen.
Dublu contrast
a)
b) c) d) e)
Examinarea computer-tomografica:
- stadierea cancerului esoIagian (extensie locala, regionala,
metastaze);
- recurenta tumorala dupa esoIagectomie;
Eco-endoscopia esofagiana:
- examinarea straturilor peretelui esoIagian (extensia
intraparietala a tumorii), adenopatii periesoIagiene;(rar Iolosita)
RADIO-IMAGISTICA ESOFAGULUI:
METODE
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EXAMEN COMPUTER EXAMEN COMPUTER- -TOMOGRAFIC: ASPECT TOMOGRAFIC: ASPECT
NORMAL AL ESOFAGULUI TORACIC NORMAL AL ESOFAGULUI TORACIC
(perete < 5 mm, net delimitat) (perete < 5 mm, net delimitat)
Semeiologia modificarilor morfologice esofagiene Semeiologia modificarilor morfologice esofagiene
rigiditatea rigiditatea parietala;
modiIicari de calibru:
- stenoza stenoza (ingustarea) lumenului esoIagian;
- dilatarea dilatarea lumenului esoIagian;
imaginea lacunara lacunara (corp strain intraluminal, tumora benigna sau
maligna mucoasa sau extramucoasa, compresiune extrinseca);
imaginea de aditie aditie (nisa, diverticul);
Rad/Imag.-Iasi-2003
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lacuna lacuna imagine de aditie imagine de aditie
stenoza stenoza dilatatie dilatatie
SEMEIOLOGIE RADIOLOGICA
Corpi straini esofagieni
- radioopaci/radiotransparenti;
Radioopaci: radiograIii simple: Iorma, contur, localizare,
semne de perIoratie;
Radiotransparenti: examen esoIagian cu contrast;
- sediu (strimtori Iiziologice);
- modiIicari Iunctionale esoIagiene;
Complicatii: perIoratia esoIagului:
- bule aerice de-a lungul peretelui posterior al esoIagului cervical
- emIizem subcutanat
- mediastinita;
Rad/Imag.-Iasi-2003
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ESOFAG,radiografii native:
CORPI STRAINI OPACI
Corp strain esofagian (cui indoit);
urmarirea progresiei prin tubul
digestiv-pina in intestin
Insigna de brav pionier
( radiograIia din anul 1960)
OAS
OAS
Buletinul radiologic
trebuie sa mentioneze:
-natura corpului,
-pozitia in esoIag,
-margini :
taioase,ascutite si
pozitia lor
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ESOFAG:CORPI STRAINI.A)capac sticla; B) radiotransparent: carne
A A
BB
...de bere..
Inel esofagian (Schatzki)(congenital ?)
-pliu transversal de mucoasa,
-deasupra jonctiunii eso-gastrice;
Examinare cu sulIat de Bariu:
- evidentiere in timpul distensiei
esoIagului;
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Rad/Imag.-Iasi-2003
Tulburari functionale esofagiene:
Primitive:
- achalazia cardiei, spasmul diIuz esoIagian, chalazia;
Secundare:
- esoIagita peptica/caustica;
- aIectare neurologica;
- bolile tesutului conjunctiv;
- boli metabolice, inIectioase;
- cancerul esoIagian (obstructie, invazie nervoasa);
Chalazia
- reIlux gastro-esoIagian /- hernie hiatala;
Diskinezii esofagiene extra-sfincteriene
Unde peristaltice secundare:
- propagare ascendenta din 1/3 inIerioara a esoIagului;
Spasm diIuz esoIagian:
Clinic: dureri 'anginoase disIagie intemitenta;
Examen baritat:
- contractii non-propulsive: 'segmentarea lumenului;
- esoIag 'in tirbuson;
Rad/Imag.-Iasi-2003
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DISKINEZIE ESOFAGIANA: DISKINEZIE ESOFAGIANA:
pseudodiverticuli Barsony pseudodiverticuli Barsony
a
b
c
a)-zone contractate inelar,alternate
cu zone dilatate,paretice;
b)-perioade alternante de relaxare;
c)esofag ~in tirbuson..
Achalazia
- absenta/relaxare insuIicienta SEI;
- lipsa concordantei peristaltica esoIagiana/relaxare SEI;
RadiograIia toracica F P:
- largirea opacitatii mediastinale (partea dreapta);
- nivel hidroaeric mediastinal;
Examenul baritat esoIagian:
- ingustare axiala a esoIagului abdominal;
- dilatare esoIag superior: megaesoIag IusiIorm, megadolicoesoIag;
- micsorarea camerei cu aer a stomacului;
- intirziere in pasajul esoIagului abdominal eIilat;
- modiIicarea peristaltismului esoIagian;
Complicatii: candidoza esoIagiana, cancer esoIagian;
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ESOFAG: ESOFAG: Achalazia cardiei:dilatarea si alungirea esofagului, Achalazia cardiei:dilatarea si alungirea esofagului,
staza, diverticuli de pulsiune prin modificarea presiunii staza, diverticuli de pulsiune prin modificarea presiunii
intraluminale intraluminale
cardia
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ACHALAZIA CARDIEI ACHALAZIA CARDIEI : DILATARE PRIN CATETER CU BALON : DILATARE PRIN CATETER CU BALON
PLASTIA ESOFAGIANA ENDOLUMINALA PLASTIA ESOFAGIANA ENDOLUMINALA- -tehnica de rad.interventionala tehnica de rad.interventionala
ACHALAZIA DILATARE POST-DILATARE
Rad/Imag.-Iasi-2003
BALON
FIR
GHID
BALON
Pasaj liber in
stomac
Diverticuli esofagieni Diverticuli esofagieni
Mecanism:
- pulsiune hernierea mucoasei submucoasei printre Iibrele
muscularei
- tractiune toate straturile peretelui esoIagian
Diverticulul Zencker
Tip: diverticul de pulsiune;
Sediu: jonctiunea Iaringo-esoIagiana;
MorIologie:
- imagine de aditie, contur net, posterior esoIagului cervical;
- impingere lateralizare esoIag cervical;
- colet mai ingust decit sacul herniar;
- dimensiuni mari; staza in diverticul;
Diverticulii esoIagului toracic mijlociu
Mecanism: tractiune (Iibroza in jurul adenopatiilor tuberculoase)
MorIologie: imagine de aditie;
Iorma conica, in deget de manusa;
colet larg; Iara staza;
Diverticuli epiIrenici
Mecanism: pulsiune;
Sediu: deasupra SEI, proiectie pe partea dreapta a conturului
esoIagian;
MorIologie: imagine de aditie, contur net;
Complicatii:
- inIlamatie;
- Iistulizare;
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DIVERTICULI ESOFAGIENI DIVERTICULI ESOFAGIENI
Diverticul de pulsiune Diverticul de pulsiune
Diverticul de Diverticul de
tractiune tractiune
Diverticuli juxtabronsici. Diverticuli juxtabronsici.
Complicatie:fistula eso Complicatie:fistula eso- -bronsica bronsica
Bariu
in
bronsia
stanga
Stenoze esofagiene benigne
Etiologie:
- post ingestie de substante caustice;
- peptice (reIlux gastro-esoIagian);
Caustice:
Examinare cu contrast (hidrosolubil primele zile, baritat ~ 3 sapt.):
- sediu: oriunde, mai Irecvent la nivelul ingustarilor(cardia);
Aspect radiologic clasic:
- stenoza n axul esoIagului (centrata), traiect lung, contururi
nete,trecere lenta spre esoIagul normal;
- dilatatie supraiacenta, cu staza baritata;
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STENOZE ESOFAGIENE POSTCAUSTICE: STENOZE ESOFAGIENE POSTCAUSTICE:
axiale, lungi, trecere lenta spre esofagul supraiacent axiale, lungi, trecere lenta spre esofagul supraiacent
Variante atipice:
- stenoze multiple: etajate sau in diIerite portiuni esoIagiene;
- inelare/tubulare;
- contururi neregulat dintate(reprezentind burjoni de regenerare a
mucoasei/submucosei post arsura caustica);
Tratament radiologic interventional:
dilatatie endoluminala cu cateter cu balon tip GRUNTZIG
esoIagoplastie transluminala(alternativa la tratamentul chirurgical)
Rad/Imag.-Iasi-2003
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ESOFAGITA POST ESOFAGITA POST- -CAUSTICA CAUSTICA: DILATARE CU CATETER : DILATARE CU CATETER
CU BALON tip GRUNTZIG CU BALON tip GRUNTZIG
PRE- DILATATIE CONTROL
recalibrare
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ESOFAGITA CAUSTICA : ESOFAGITA CAUSTICA :
Complicatie: Complicatie:
FISTULA ESO FISTULA ESO- -BRONSICA BRONSICA
DILATATIE CU TUB RIGID : DILATATIE CU TUB RIGID :
(metoda veche (metoda veche- -practicata in practicata in
sectiile de ORL): sectiile de ORL):
PERFORATIA ESOFAGULUI PERFORATIA ESOFAGULUI
EsoIag
rupt:bariu in
mediastin
sonda
Bariu in bronsia stanga
Stenoze peptice
Sediu:
- 1/3 inIerioara a esoIagului;
- asociere cu ulcerul peptic;
- stenoza centrata n axul esoIagului, trecere lenta
spre esoIagul normal;
Ulcerul peptic:
- imagine de aditie, dimensiuni mici, situata
pe portiunea stenozata;
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STENOZA PEPTICA STENOZA PEPTICA ULCER PEPTIC ULCER PEPTIC
Rad/Imag.-Iasi-2003
-stenoza,nisa spiculara si
dilatatie supraiacenta
cardia
Stenoza scurta,dilatatie moderata
supraiacenta,pliuri ingrosate
Varice esofagiene
Etiologie Etiologie: Hipertensiunea Portala (HTP)-80 din ciroze
Examen endoscopic-prima optiune;
Examen Fluoroscopic: susp. Bariu concentrata,strat fin;
- sediu: 1/2 inferioara a esofagului;
- imagini lacunare in banda, sinuoase;
- imagini lacunare cu caracter ~vermiform
- modificare la manevra Valsalva:se ingroasa in apnee si
expir cu glota inchisa;se alungesc in expir.
Rad/Imag.-Iasi-2003
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VARICE ESOFAGIENE: examen in strat subtire VARICE ESOFAGIENE: examen in strat subtire
VALSALVA VALSALVA Suplete parietala Suplete parietala
Tumori benigne
Leiomiomul
-cea mai Irecventa tumora benigna esoIagiana
-sediu: 1/3 inIerioara, 1/3 mijlocie;
Examen baritat:
- deIect de umplere, margini nete;
- amprenta ingustare lumen
- pliuri de mucoasa intacte;
Examenul CT /IRM-aduc detalii suplimentare
Rad/Imag.-Iasi-2003
TUMORA BENIGNA: TUMORA BENIGNA:
LEIOMIOM LEIOMIOM
Rad/Imag.-Iasi-2003
Tumori maligne esofagiene
- carcinom epidermoid;
- adenocarcinom (metaplazie gastrica);
Infiltrant:
- stenoza excentrica Iata de axul esoIagului;
- jonctiune asimetrica cu esoIagul
supraiacent;
- absenta distensiei la trecerea bolului opac;
- dilatatie supraiacenta a esoIagului;
Vegetant:
- lacuna/deIect de umplere;
- stenoza neregulata, excentrica a lumenului;
- ulceratii in lacuna;
- obliterare completa a lumenului;
Ulcerant:
Nisa maligna:
- nisa plata, incastrata;
- nu proemina/Ioarte putin din contur;
- burelet periulceros, umeri simetrici;
Forme mixte: evolutie spre stenoza, obstructie;
CANCER ESOFAGIAN CANCER ESOFAGIAN
INFILTRANT VEGETANT INFILTRANT VEGETANT
Rad/Imag.-Iasi-2003
insert it again.
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ULCERANT ULCERANT
CANCER ESOFAGIAN CANCER ESOFAGIAN
FARINGO FARINGO- -
ESOFAGIAN ESOFAGIAN
ESO ESO- -CARDIO CARDIO- -
TUBEROZITAR TUBEROZITAR
Nisa maligna
Stenoza excentrica
Rad/Imag.-Iasi-2003
Bilantul operabilitatii
Extensie loco-regionala si la distanta:
Endoscopie biopsie;
Examen baritat eso-gastro-duodenal: lungimea leziunii;
Examen computer-tomograIic (mediastin si abdomen superior):
- invazia traheo-bronhica; invazia aortei;
- extensie ganglionara mediastinala;
- extensie metastatica: plamin, Iicat;
- control post-terapeutic;
Eco-endoscopie esoIagiana;
Imagistica prin rezonanta magnetica;
Rad/Imag.-Iasi-2003
Esofagul operat
Metode de imagistica:
radiografia simpla toracica si abdominala; radiografia simpla toracica si abdominala;
examinarea cu contrast: hidrosolubil (precoce); sulfat de Bariu (tardiv); examinarea cu contrast: hidrosolubil (precoce); sulfat de Bariu (tardiv);
examinare computer examinare computer- -tomografica; tomografica;
Tehnici chirurgicale:
- chirurgia reIluxului gastro-esoIagian si a herniei hiatale;
- esoIagectomii intinse:
inIerioare, cu anastomoza eso-gastrica mediastinala;
superioare, cu anastomoza eso-gastrica cervicala;
totale, cu anastomoza Iaringo-gastrica;
esoIagectomie cu anastomoza eso-colica;
Perioada post-operatorie precoce,
Perioada post-operatorie intermediara,
Perioada post-operatorie tardiva,
EsoIagoplastie cu stomac EsoIagoplastie cu stomac
netunelizat: radiograIie toracica netunelizat: radiograIie toracica
aspect normal in perioada aspect normal in perioada
postoperatorie precoce postoperatorie precoce
EsoIagoplastie cu ileocolon
control cu GastrograIin in
perioada postoperatorie precoce
again.
CONTROLUL BARITAT AL ESOFAGULUI OPERAT CONTROLUL BARITAT AL ESOFAGULUI OPERAT
Esofagoplastie presternala Esofagoplastie presternala Esofagoplastie cu tub gastric Esofagoplastie cu tub gastric
Interventii chirurgicale limitate:
- rezectia diverticulilor;
- miotomii esoIagiene;
- ablatia tumorilor extramucoase;
Tehnici interventionale:
- dilatare, cu sonda cu balonas, a leziunilor stenozante (stenoze
benigne, achalazia cardiei);
- 'stent esoIagian pentru tumorile maligne;
Rad/Imag.-Iasi-2003
Metode radio-imagistice
Examen cu substanta de contrast:
- pregatirea pacientului;
- suspensie de sulIat de Bariu: contrast simplu, dublu contrast;
- examinare Iluoroscopica compresiune dozata rdgI. tintite;
- contrast iodat hidrosolubil: perIoratii, peritonita, postoperator precoce;
Ecografia transparietala: ingrosarea peretelui gastric, structurile din jur;
Eco-endoscopia: evidentierea straturilor parietale, adenopatii regionale;
Examinarea computer-tomografica: stadializarea tumorilor;
Metode izotopice: hemoragii;
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STOMAC NORMAL: TEHNICA EXAMINARII RX STOMAC NORMAL: TEHNICA EXAMINARII RX
Strat subtire:
evidentierea pliurilor
de mucoasa
corporeala
Repletie: evaluarea
calibrului si
peristaltismului
Trendelenburg: reflux
gastro-esofagian
FORNIX
CORP
PORTIUNE
VERTICALA
ANTRUM
STOMAC:A)EXAMEN IN STRAT SUBTIRE; STOMAC:A)EXAMEN IN STRAT SUBTIRE;
B)DUBLU CONTRAST. B)DUBLU CONTRAST.
A
B
nisa
edem
Pliuri de mucoasa normala
Mucoasa stearsa,edematoasa
edem
Pliuri convergente
spre nisa
STOMAC NORMAL: EXAMEN BARITAT
evaluarea in dublu contrast a antrului si fornixului
antrum
pilor
bulb
Iornix
Anomalii de pozitie
Hernia hiatala: trecere intermitenta/permanenta a unei
portiuni din
stomac prin oriIiciul hiatal;
Clasificarea Ackerlund Clasificarea Ackerlund:
- tip I: brahiesoIag HH;
- tip II: paraesoIagiana (rostogolire);
- tip III: alunecare;
Diagnostic. radiologic:
- RadiograIia simpla: camera cu aer in mediastinul posterior;
- Ex. baritat: esoIag, pozitia cardiei, tipul de hernie, reduc-
tibilitate,reIlux gastro-esoIagian;
HERNII HIATALE: A) prin alunecare; B) prin rostogolire HERNII HIATALE: A) prin alunecare; B) prin rostogolire
A
B
diaIragm
cardia
esoIag
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HERNII HIATALE PRIN ALUNECARE (TIP III) HERNII HIATALE PRIN ALUNECARE (TIP III)
Rad/Imag.-Iasi-2003
diaIragm
diaIragm
Pozitie :
Trendelenburg
Pozitie:ortostatism
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HERNII HIATALE:BRAHIESOFAG HERNII HIATALE:BRAHIESOFAG
esofag esofag
diafragm diafragm
cardia cardia
Stomac
herniat
Amprente si deplasari gastrice
- hepatomegalie, splenomegalie, mase pancreatice;
Stomac in cascada
- compresiunea polului superior gastric prin colon meteorizat;
- marea curbura aliniata diaIragmului: punga superioara/inIerioara;
- proIil: 'stomac obscen;
Volvulusul gastric
- longitudinal: dupa axul cardio-piloric;
- transversal (mezenterico-axial);
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insert it again.
STOMAC: MODIFICARI DE POZITIE/AMPRENTE
Amprenta data de
pseudochist de pancreas
corporeal
VOLVULUS GASTRIC VOLVULUS GASTRIC
Volvulus de pol superior -
stomac in cascada
Volvulus mezenterico-axial
Rad/Imag.-Iasi-2003
VOLVULUS GASTRIC
Mica curbura
cardia
cardia
Gastrite
Diagnostic: ex. endoscopic /- examen baritat eso-gastro-duodenal;
Gastrita acuta
- etiologie: alcool, salicilati, aIectare inIectioasa;
- aspect radiologic: - pliuri ingrosate (~ 5mm, pseudopolipoid),
- eroziuni mucoase superIiciale, inconjurate de
edem (aspect 'varioliIorm),
- hipersecretie gastrica;
Gastrita hipertroIica (boala Menetrier)
- hipertroIie importanta a pliurilor corpului gastric (~ 1cm),
apect pseudo-cerebriIorm, /- gastro-enteropatie exudativa;
again.
GASTRITA GASTRITA GASTRITA MENETRIER GASTRITA MENETRIER
ULCERUL GASTRIC
- Dg. radiologic: examen baritat eso-gastro-duodenal;
- semne directe semne indirecte
Semne directe: nisa nisa edem periulceros convergenta pliurilor;
- sediu: tipic: portiunea verticala a micii curburi;
- profil : imagine de aditie;
- Iorma: variata: rotunda, triunghiulara, ascutita;
- dimensiuni variate: 5-10 mm mari (nisa Haudeck);
- contur precis, cu/Iara colet;
- delimitata superior/inIerior: dig periulceros;
- semnul Hampton: banda transparenta subcavitara-reprezinta edemul
periulceros vazut din proIil;
- fata: imagine 'in cocarda(insemnul revolutiei Iranceze-tricolorul
dispus concentric);
insert it again.
NISA GASTRICA ULCEROASA NISA GASTRICA ULCEROASA
imaginea de profil imaginea de profil
nisa
edem
edem
nisa
Semnul
indexului
Bara transparenta
subcavitara
(s.Hampton)
ULCERE GASTRICE: ULCERE GASTRICE:
nisa, convergenta pliurilor nisa, convergenta pliurilor
Rad/Imag.-Iasi-2003
Imagine de proIil
Imagine de Iata
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NISA GASTRICA ULCEROASA (benigna) NISA GASTRICA ULCEROASA (benigna)
imaginea de fata: nisa, edem, convergenta pliurilor imaginea de fata: nisa, edem, convergenta pliurilor
Rad/Imag.-Iasi-2003
Cicatrizarea nisei dupa
tratament
NISA
HALOU EDEM
Compresor-localizator
Semne indirecte
- triada Barclay: hiperkinezie, hipertonie, hipersecretie;
- gastrita hipertroIica de insotire;
- semnul 'indicatorului: la nivelul marii curburi gastrice;
- rigiditatea micii curburi;
- spasm antral, spasm piloric;
Aspecte particulare in functie de localizare
- - nisa nisa in lacuna (pe marea curbura);
- nisa nisa subcardiala # diverticul subcardial;
- nisa nisa la unghiul micii curburi: Ienomene de rigiditate;
Ulcerul canalului piloric
- nisa nisa spasm piloric imagine de 'perla pe ata;
ULCER PE MAREA ULCER PE MAREA
CURBURA GASTRICA: CURBURA GASTRICA:
nisa si edem. nisa si edem.
ULCER PILORIC ULCER PILORIC
EVOLUTIE, COMPLICATII
Favorabila - sub tratament: diminuare, disparitie, cicatrice;
Nefavorabila:
- marirea ulcerului: nisa Haudeck;
- stenoza gastrica;
- penetratie (pancreas, Iicat, mezocolon);
- perIoratie: pneumoperitoneu (rdgI. simpla); ex. contrast hidrosolubil;
- hemoragie digestiva superioara;
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NISA HAUDECK NISA HAUDECK
STENOZA STENOZA
PILORICA: PILORICA:
Stomac dilatat, Stomac dilatat,
alungit, cu importanta alungit, cu importanta
staza si evacuare staza si evacuare
pilorica pilorica
tardiva/absenta tardiva/absenta
Diagnostic diferential: Diagnostic diferential:
DIVERTICUL GASTRIC DIVERTICUL GASTRIC --
fara edem, pliurile de mucoasa fara edem, pliurile de mucoasa
patrund in diverticul patrund in diverticul
Tumori gastrice benigne Tumori gastrice benigne
Polipi gastrici Polipi gastrici
2 variante: - hiperplazici hiperplazici mai Irecventi
- lacune 1 cm, net delimitate
- Iara potential de malignizare
- adenomatosi adenomatosi mai mari
- sesili/pediculati (mai ales in antru)
- potential de malignizare
Leiomiom, neurinom, lipom, fibrom Leiomiom, neurinom, lipom, fibrom
- -Rare; localizarea tumorii este extramucoasa
-Ex. baritat imagini lacunare rotunde, net delimitate
- ulceratii (leiomiom)
-Ecografia, CT: extensia masei submucoase
POLIPI GASTRICI
-examen cu
dublu contrast-
insuIlatie;
-imagini multiple
protruzive in
lumen,mulate cu
strat Iin opac,
contur net,
dimensiuni mici
CANCERUL GASTRIC
Debut (~early gastric cancer)
Invazie limitata la mucoasa si submucoasa,
Iara aIectare ganglionara
sau metastaze la distanta.
- tip I: proeminent (h ~ 0,5 cm);
- tip II: superIicial:
- II a: elevat;
- II b: plat;
- II c: depresionat;
- tip III: excavat;
CANCER GASTRIC CANCER GASTRIC
LA DEBUT TIP III LA DEBUT TIP III
-zona
depresata,lizereu
marginal
sters,neregulat,
halou si pliuri
adunate catre
leziune
Rad/Imag.-Iasi-2003
in perioada de stare in perioada de stare
VEGETANT
INFILTRANT
CANCER GASTRIC AVANSAT
Vegetant:
- masa tumorala exoIitica intraluminala necroza, ulceratie;
- defect de umplere/lacuna, defect de umplere/lacuna, delimitare imprecisa, distructia peretelui;
Infiltrant:
- ingrosarea peretelui;
- rigiditate, absenta peristalticii, rigiditate, absenta peristalticii,
- distrugerea mucoasei;
- ingustatarea lumenului gastric schir gastric;
Ulcerant:
- - nisa maligna, nisa maligna,
- proIil: 'menisc, contur rectiliniu, in limitele peretelui, dig
periulceros cu umerii egali, pliuri inIiltrate oprite la distanta de nisa;
CANCER VEGETANT & CANCER VEGETANT &
ULCERAT ULCERAT
Lacuna cu rest de
bariu central
CANCER GASTRIC VEGETANT CANCER GASTRIC VEGETANT
tum
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have to delete the image and then insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. !f the red x still appears, you may have to delete the image
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CANCER CANCER
GASTRIC GASTRIC
INFILTRANT INFILTRANT
'Schir gastric
Examen in plenitudine
Dublu contrast
Rigiditate segmentara
'pliu mort in picioare.
insert it again.
ULCERANT ULCERANT
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Menisc
canceros
CANCER GASTRIC VEGETANT SI ULCERANT CANCER GASTRIC VEGETANT SI ULCERANT
Limfoame gastrice
- non Hodgkin/Hodgkin;
Macroscopic: polipoid, ulcerant, inIiltrant;
spect radiologic. spect radiologic.
- mucoasa proeminenta ingrosarea pliurilor;
- multiple eroziuni ulceratii;
Examinare ecografica, Examinare ecografica,
Examinare computer Examinare computer- -tomografica, tomografica,
RADIODIAGNOSTICUL STOMACULUI OPERAT
Interventii conservatoare:
- vagotomie: totala ( piloroplastie); selectiva;
- gastroenteroanastomoza: ansa jejunala la marea curbura gastrica;
Rezectii gastrice:
- partiale;
- subtotale: rezectie 2/3 distala anastomoza gastro-duodenala,
gastro-jejunala;
- totale anastomoza eso-jejunala;
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TIPURI PRINCIPALE DE REZECTIE GASTRICA SI TIPURI PRINCIPALE DE REZECTIE GASTRICA SI
ENTERO ENTERO - - ANASTOMOZE ANASTOMOZE
PEAN PEAN- -BILROTH BILROTH
termino termino- -terminala terminala
REICHEL REICHEL- -POLYA POLYA
termino termino- -laterala laterala
ROUX ROUX- -BROWN BROWN
eso eso- -jejunala ~Y jejunala ~Y
Complicatii precoce
- dezunirea suturilor peritonita: nivel hidroaeric subdiaIragmatic
(rdgI. abdominala simpla);
- ocluzii: rdgI. abdominala simpla;
- Iistule: examinare cu substanta de contrast hidrosolubila;
Complicatii tardive
Sindroame Iunctionale
- reIlux gastro-esoIagian: post gastrectomie polara superioara;
- sindrom de ansa aIerenta: staza baritata in ansa aIerenta;
- sindrom de ansa eIerenta (dumping syndrome): evacuare
precipitata si distensia accentuata a eIerentei;
Sindroame organo-functionale
- gastrita bontului;
- stomita, jejunita;
Afectiuni organice
- invaginatia acuta/cronica a ansei aIerente/eIerente;
- prolapsul mucoasei gastrice;
- ulcerul peptic: gura de anastomoza, ansa eIerenta (primii 5 cm);
- cancerul pe bont: recidiva; primitiv
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ULCER PEPTIC POST ULCER PEPTIC POST- -OPERATOR OPERATOR
GEA REICHEL GEA REICHEL- -POLYA POLYA GEA TIP PEAN GEA TIP PEAN- -BILROTH BILROTH
insert it again.
STENOZA GURII DE ANASTOMOZA: A)ulcer; B) cancer STENOZA GURII DE ANASTOMOZA: A)ulcer; B) cancer
insert it again.
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STOMAC OPERAT : COMPLICATII STOMAC OPERAT : COMPLICATII
Ulcer anastomotic Ulcer anastomotic
Stenoza gurii de anastomoza Stenoza gurii de anastomoza Neoplasm de Neoplasm de
bont gastric bont gastric
Lichid de
staza
stenoza
ReIlux in ansa
aIerenta
Rad/Imag.-Iasi-2003
METODE in Radio- imagistica duodenului
Examinarea cu substanta de contrast
- sulIat de Bariu: contrast simplu/dublu contrast;
- probe Iarmacodinamice: duodenograIia hipotona;
- contrast hidrosolubil: perIoratii;
EcograIia: peritonite localizate secundare perIoratiilor acoperite,
extensia locala a tumorilor
Eco-endoscopia: modiIicari parietale
Examinarea computer-tomograIica: extensie tumorala
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DUODEN: DUODEN:
EXAMEN BARITAT EXAMEN BARITAT
Plenitudine Plenitudine Strat subtire/relief mucos Strat subtire/relief mucos
BULB DUODENAL BULB DUODENAL
CADRU DUODENAL IN DECUBIT CADRU DUODENAL IN DECUBIT
Modificarile de pozitie
Duoden invers Duoden invers
Duoden in ~M Duoden in ~M
Compresiuni de vecinatate Compresiuni de vecinatate: :
- vezicula biliara;
- tumori vateriene;
- tumori pancreas ceIalic;
- tumori renale drepte;
Aderente si tractiuni post Aderente si tractiuni post- -inflamatorii; inflamatorii;
AMPRENTE DE VECINATATE PE DUODEN AMPRENTE DE VECINATATE PE DUODEN
COLECIST COLECIST
ADENOPATII
DUODEN : MODIFICARI DE POZITIE DUODEN : MODIFICARI DE POZITIE
D2 lung:hamac
Ulcerul duodenal bulbar-semne radiologice
Nisa semnul direct
semne indirectemodiIicarile mucoasei:
-edem, convergenta pliurilor,modiIicari de contur bulbar
Forme anatomo-radiologice:
Edematoasa:
- bulb nedeIormat;
- nisa edem periulceros imagine 'in cocarda;
Forma edemato-scleroasa:
- contur bulbar cu incizuri si ancose;
- nisa edem periulceros benzi de Iibroza in submucoasa;
Forma sclero-edematoasa
- deIormarea bulbului:
stenoza, biloculare,
dilatatie pre-stenotica ('diverticul Cole);
- identiIicare diIicila a nisei;
Fenomene de insotire:
- gastro-duodenita
ULCER DUODENAL BULBAR ULCER DUODENAL BULBAR
FORMA EDEMATOASA FORMA EDEMATOASA
FORMA SCLERO-EDEMATOASA SCLERO-CICATRICIAL
ULCER BULBAR ULCER BULBAR
STENOZANT: STENOZANT:
DIVERTICULI DIVERTICULI
SECUNDARI SECUNDARI
COLE (1) & COLE (1) &
ACKERLUND(2) ACKERLUND(2)
11
22
Rad/Imag.-Iasi-2003
ULCER BULBAR DUBLU:KISSING ULCER BULBAR DUBLU:KISSING- -ULCER ULCER
Complicatii:
- perforatie: pneumoperitoneu; penetratie
- hemoragie digestiva;
Ulcer duodenal post-bulbar
- obs. Sdr. Zollinger-Ellison;
- sediu: D2 supravaterian;
- nisa spasm de insotire ('perla pe ata);
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ULCER DUODENAL POSTBULBAR ULCER DUODENAL POSTBULBAR
ULCER BULBAR PERFORAT IN ULCER BULBAR PERFORAT IN
MAREA CAVITATE PERITONEALA: MAREA CAVITATE PERITONEALA:
examinare cu GASTROGRAFIN examinare cu GASTROGRAFIN
ULCER PERFORAT: PNEUMOPERITONEU ULCER PERFORAT: PNEUMOPERITONEU
semiluna aerica subdiafragmatica bilateral semiluna aerica subdiafragmatica bilateral
STENOZA STENOZA
PILORICA PILORICA
ULCEROASA, ULCEROASA,
DECOMPENSATA DECOMPENSATA
Rad/Imag.-Iasi-2003
Diverticulii duodenali
Mecanism: pulsiune
Sediu: Irecvent D
2
, in interiorul potcoavei duodenale;
MorIologie: imagine de aditie,
contur net,
prelungire de pliuri in interior;
DIVERTICULI DUODENALI DIVERTICULI DUODENALI
Stenoze duodenale
- medio-bulbara: dupa ulcer bulbar duodenal;
- D
2
: T cap de pancreas: cadru largit,
pliuri sterse,
stenoza, cauciuc 'pe janta
ampulom vaterian
tumori duodenale
- D
3
: pensa mezenterica;
Stenoza portiunii descendente Stenoza portiunii descendente
a duodenului in formatiuni a duodenului in formatiuni
expansive pancreatice expansive pancreatice
LARGIREA CADRULUI LARGIREA CADRULUI
DUODENAL IN CANCER DUODENAL IN CANCER
PANCREATIC CEFALIC PANCREATIC CEFALIC
PENSA AORTO PENSA AORTO- -MEZENTERICA MEZENTERICA
Tumori duodenale Tumori duodenale
-rare;
-polipi: imagini lacunare bine delimitate,
dimensiuni mici;
-schwanom, leiomiom: stergerea pliurilor, ulceratii;
-adenocarcinom: stenoza neregulata, excentrica
-limIom: stergerea pliurilor, stenoza
POLIPI DUODENALI POLIPI DUODENALI
Schwanom duodenal Schwanom duodenal: stergerea pliurilor, ulceratie : stergerea pliurilor, ulceratie
Rad/Imag.-Iasi-2003
EXPLORAREA RADIO-IMAGISTICA A INTESTINULUI
SUBTIRE
RadiograIia abdominala simpla: distensia anselor, nivele hidro-aerice
Tranzitul baritat: 600-900 ml suspensie baritata, urmarire in
Iluoroscopie, rdgI. tintite, compresiune dozata, contrast simplu/dublu
contrast;
-pozitia anselor, pliuri, calibru;
Enteroclisma: tub nazo-gastric pina la unghiul Treitz, contrast
simplu,dublu contrast, Iluoroscopie rdgI. tintite;
modiIicatori de comportament:
acceleratori ai tranzitului: lichide reci, neostigmina,
metoclopramida;
inhibitori ai tranzitului: Buscopan, morIina, codeina, atropina;
-pozitia anselor, aspectul mucoasei, calibru;
OpaceIiere retrograda (dupa clisma baritata): examinarea ultimelor
anse ileale;
OCLUZIE INTESTINALA INALTA :NIVELE HIDROAERICE OCLUZIE INTESTINALA INALTA :NIVELE HIDROAERICE
~POTCOAVA ~POTCOAVA
~Trepte de scara ~Trepte de scara
RADIOGRAFIA ABDOMINALA FARA CONTRAST
EXAMEN BARITAT INTESTINAL: EXAMEN BARITAT INTESTINAL:
A) Tranzit baritat; B) pe sonda:enteroclisis A) Tranzit baritat; B) pe sonda:enteroclisis
A A
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BB
sonda
EXAMEN BARITAT 1E1UNAL:ASPECT NORMAL EXAMEN BARITAT 1E1UNAL:ASPECT NORMAL
Examinare computer-tomografica
- umplerea anselor cu contrast diluat hidrosolubil;
- nivelul obstructiei sau perIoratiei, ingrosarea peretilor, abcese
intre anse;
Explorare izotopica:
Tc
99
hematii: diagnosticul hemoragiei intestinale;
Indium
111
leucocite: diagnosticul leziunilor inIlamatorii;
Biopsia leziunilor IS: ghidaj ecograIic/computer-tomograIic;
Semeiologia radiologica a IS
Semne functionale:
- hiper/hipotonia;
- tonus alternant;
- hiper/hipokinezia;
- aeroenteria;
- imagini hidro-aerice;
Semne organice:
- alterarea relieIului mucoasei: relieI edematos;
- rigiditatea segmentara:
- stenoza;
- lacuna;
- imagini de aditie;
DISKINEZIE DISKINEZIE
INTESTINALA INTESTINALA
HIPERTONA HIPERTONA
Boala Crohn
AIectare granulomatoasa, idiopatica, evolutie cronica, adult tinar;
Sediu: predilect ileon terminal;
Dg. Imagistic: explorare cu substanta de contrast imagistica
sectionala (ecograIie, CT);
Evolutie:
Debut:
- edemul mucoasei: aspect Iin granular;
- ingrosarea pliurilor: pliuri neregulate, IuziIorme, nodulare;
- hipertroIia Ioliculilor limIatici/placi Peyer: lacune juxtapuse,
contururi poligonale, 'nodul de alarma;
- ulceratii: initial 'aItoide: eroziunea mucoasei de acoperire a
Ioliculilor limIatici hipertroIiati: nisa in lacuna (Iata), imagine de
aditie (proIil);
- aspect ulcero-nodular: 'pavaj cu dale ('cobblestone);
Scleroza si stenoza:
- semnul corzii 'string sign: ingustare tubulara a lumenului;
- stenoze scurte, etajate, 'in clepsidra;
- dilatare in amonte a anselor;
- cecul nu se opaceIiaza: semnul 'saltului;
- ingrosare si retractie mezenterica a anselor hipertroIia ggl.
limIatici;
- Iistule (intre anse, intre ansa patologica si vezica);
BOALA CROHN ST I BOALA CROHN ST I
BOALA CROHN: FAZA ULCERATIVA (ST.II) BOALA CROHN: FAZA ULCERATIVA (ST.II)
BOALA CROHN: FAZA BOALA CROHN: FAZA
ULCERATIVA SI STENOZANTA ULCERATIVA SI STENOZANTA
(ST.III) (ST.III)
Caracteristici fundamentale: Caracteristici fundamentale:
- gradare in severitatea leziunilor, cu aparitie pe sarite: 'skip lesions;
- tendinta la aparitie pe marginea mezenterica a intestinului;
Imagistica sectionala
Ecografia:
- ingrosarea peretelui intestinal; prezenta abceselor;
Computer-tomografia:
- ingrosarea peretelui ingustarea lumenului;
- hipertroIia grasimii mezenterice peri-ileale;
- adenopatii mezenterice;
- abcese interanse si extraintestinale;
Tuberculoza ileo-cecala
AIectiune inIlamatorie speciIica, localizare predilecta pe ultima
ansa ileala si portiunea proximala a colonului;
Cale de diseminare: hematogena, alimentara;
Dg. Imagistic: enteroclisma, tranzit baritat;
Debut: Debut:
- ansa ileala dilatata, hipotona; edem al mucoasei: pliuri ingrosate,
neregulate;
- hipertroIia Ioliculilor limIatici: imagini lacunare multiple, nodul
de alarma;
Perioada de stare: Perioada de stare:
- ulceratii prin necroza de cazeiIicare a Ioliculilor;
- ulceratii multiple, in 'buton de camasa;
- 'string sign
Evolutie: Evolutie:
- reactie de Iibroza, cu stenoze, scurtari, retractii si Ienomene
obstructive asociate;
- retractia marginii externe a cecului 'cec amputat, valvula
ileo-cecala beanta;
Forma pseudo-tumorala: asemanatoare cancerului vegetant;
Examinarea C1: Examinarea C1:
- ascita, adenopatii, noduli peritoneali, ghidaj pentru punctie-
aspiratie cu ac Iin;
TUBERCULOZA ILEO TUBERCULOZA ILEO- -CECALA CECALA- -DEBUT: DEBUT:
HIPERTROFIE PLACI PEYER;MICROULCERATII HIPERTROFIE PLACI PEYER;MICROULCERATII
TUBERCULOZA ENTERO-PERITONEALA:
Anse aderente, stenozate, cu retractii; peritonita plastica, adeziva
Diverticuli intestinali
- pulsiune/tractiune, marginea mezenterica a IS;
- imagini de aditie, in care patrund pliurile mucoasei;
Diverticul Meckel
Relicvat embrionar al canalului omIalo-mezenteric;
Sediu:
- ileon, la o distanta de ~ 50cm de cec;
Examen cu contrast: Examen cu contrast:
- imagine de aditie, pe marginea antimezenterica a ileonului,
perpendiculara pe acesta;
- lungime: 1 - 25 cm;
Complicatii: Complicatii:
- hemoragie (ulcer pe insule de mucoasa gastrica);
- inIectie, ocluzie;
DIVERTICUL DIVERTICUL
MECKEL MECKEL
Tumori intestinale
Tipuri anatomo-patologice: carcinoid;
adenocarcinom;
limIom;
InIiltrante: stenoze neregulate, excentrice,
obstructie;
Vegetante: stergerea pliurilor, lacuna in lumen;
Ulcerante: nisa in lacuna;
Carcinoid ileal: Carcinoid ileal:
imagine lacunara la nivelul ultimei anse ileale, dilatarea anselor in imagine lacunara la nivelul ultimei anse ileale, dilatarea anselor in amonte amonte
Parazitoze intestinale
Ascaris lumbricoides: banda transparenta,
rectilinie/sinuoasa;
- tranzit baritat ascarid-bariu liniar in interior;
- ocluzie intestinala-prin ghem de ascarizi;
Taenia parazit voluminos-banda transparenta
lata si aspect tipic ceIalic (Iatetat)
ASCARIZI IN ASCARIZI IN
1E1UN 1E1UN
EVIDENTIATI EVIDENTIATI
PRIN PRIN
TRANZIT TRANZIT
BARITAT BARITAT
TAENIA TAENIA
VIZUALIZATA IN VIZUALIZATA IN
INTESTIN INTESTIN
PRIN EX BARITAT PRIN EX BARITAT
CAP SI
PROGLOTA
CORP
Rad/Imag.-Iasi-2003
METODE RADIO-IMAGISTICE
Radiografia abdominala simpla
- calciIicari, colectii aerice si hidroaerice anormale, pregatirea
pacientului inaintea clismei baritate;
Clisma baritata
- pregatirea pacientului: regim alimentar, laxative, clisme
evacuatorii;
- contrast simplu, evacuare, dublu contrast;
- examinare in Iluoroscopie, rdgI. tintite, compresiune dozata;
Indicatii:
- dublu contrast: supraIata mucoasei (leziuni de dimensiuni mici);
- contrast simplu: leziuni polipoide, ulcerative, obstructive, cu
dimensiuni mari, detectarea Iistulelor;
CLISMA BARITATA:EXAMEN IN PLENITUDINE CLISMA BARITATA:EXAMEN IN PLENITUDINE
CLISMA BARITATA: CLISMA BARITATA:
A) examen post A) examen post- -evacuare>relief mucos; evacuare>relief mucos;
B) ex. post B) ex. post- -insuflatie gazoasa> dublu contrast insuflatie gazoasa> dublu contrast
A A
BB
Examinarea cu substanta de contrast hidrosolubila:
- suspiciune de perIoratie intestinala, suspiciune de Iistula colo-
vezicala, explorarea unei Iistule externe;
Ecografie trans-rectala:
- stadierea tumorilor rectale;
Examinare CT:
- perete colic extensie transparietala;
- abcese mase inIlamatorii;
- metastaze limIatice, hepatice, peritoneale;
Imagistica prin rezonanta magnetica:
- regiunea recto-sigmoidiana;
Anomalii de pozitie ale colonului
- congenitale/dobindite;
Situs inversus
- inversiune totala a cadrului colic: cec la stinga, sigmoid la dreapta;
Mezenter comun:
- anomalie de rotatie;
- duoden si unghi Treitz in pozitie normala, jejun in dreapta
abdomenului, ileon si colon anterior si la stinga;
Sindrom Chilaiditi:
- interpozitie (Iixa/tranzitorie) a colonului intre Iicat si diaIragm;
ANOMALII DE POZITIE: MEZENTER COMUN ANOMALII DE POZITIE: MEZENTER COMUN
ansele intestinale localizate in jumatatea dreapta a abdomenului, valva ileo ansele intestinale localizate in jumatatea dreapta a abdomenului, valva ileo- -cecala la cecala la
nivel pelvin, colon ascendent pe linia mediana nivel pelvin, colon ascendent pe linia mediana
ANOMALII DE ANOMALII DE
LUNGIME: LUNGIME:
MEGA MEGA- -DOLICO DOLICO- -
COLON COLON
Hernie diafragmatica a colonului:
- congenitala (agenezie totala/partiala a diaIragmului)/dobindita;
#dgf simpla: imagini hidroaerice in torace;
Clisma baritata: evidentierea segmentului herniat;
Cec in pozitie inalta, subhepatica;
Ptoza colica: evidentiata prin clisma baritata;
Deplasarea colonului prin procese de vecinatate;
tumori retroperitoneale, renale, pancreatice, hepatice, splenice; tumori retroperitoneale, renale, pancreatice, hepatice, splenice;
abcese (plastron apendicular); abcese (plastron apendicular);
splenomegalie, hepatomegalie splenomegalie, hepatomegalie
ANOMALII CONGENITALE: CEC RECURBAT ANOMALII CONGENITALE: CEC RECURBAT
Rad/Imag.-Iasi-2003
insert it again.
Plastron apendicular: Plastron apendicular:
amprenta asupra cecului si
ultimei anse ileale
Rectocolita ulcero-hemoragica
AIectiune inIlamatorie cronica, cu etiologie necunoscuta si evolutie
in pusee;
Dg. Imagistic:
#adiografia #adiografia abdominala abdominala simpla simpla. .
- prezenta megacolonului toxic (contraind. pentru clisma baritata);
Clisma Clisma baritata baritata. .
- prezenta, extinderea bolii /- complicatii;
- modiIicari Iunctionale: hipertonie, hiperkinezie, modiIicarea
haustrelor;
- modiIicarea mucoasei: aspect granular, edemul mucoasei;
- ulceratii: pete opace (Iata); imagini de aditie (proIil);
- proIil: spiculi, Iorma de 'T, 'buton de camasa, contur dublu
al colonului;
- modiIicari de tip polipoid: imagini pseudo-lacunare (regenerarea
mucoasei);
Cronicizare:
- disparitia relieIului mucoasei, scurtarea segmentelor colice,
deschiderea unghiurilor colice, lipsa haustratiilor;
- stenoze tubulare (microcolon);
Complicatii:
- megacolon toxic;
- perIoratii (in peritoneu sau organele vecine);
- stricturi;
- potential de malignizare;
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RECTOCOLITA RECTOCOLITA
ULCERO ULCERO- -HEMORAGICA ST I: HEMORAGICA ST I:
edem, stergerea haustatiilor, edem, stergerea haustatiilor,
imagini lacunare imagini lacunare
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RECTOCOLITA ULCERO RECTOCOLITA ULCERO- -HEMORAGICA HEMORAGICA
ST II: ULCERATII & PSEUDOPOLIPI ST II: ULCERATII & PSEUDOPOLIPI
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. !f the red x still appears, you may have to delete the image and then insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. !f the red x still
RECTOCOLITA ULCERO RECTOCOLITA ULCERO- -HEMORAGICA: HEMORAGICA:
PSEUDOPOLIPI & ULCERATII PSEUDOPOLIPI & ULCERATII
RECTOCOLITA
ULCERO-HEMORAGICA:
ST III:
FORMA STENOTICA~
MICROCOLON
Rad/Imag.-Iasi-2003
Diverticulii colonului
Sediu: sigmoid;
Diverticuli simpli:
- clisma baritata: imagini de aditie multiple, dimensiuni variate;
- atasate prin pedicul lumenului colic;
- asociere cu spasm colic la acelasi nivel;
Diverticulita:
- saci diverticulari deIormati, aspect neregulat si umplere
neomogena;
- abces pericolic: US/CT;
- extravazarea contrastului, traiect paralel cu peretele colic;
DIVERTICULOZA COLONICA DIVERTICULOZA COLONICA
Rad/Imag.-Iasi-2003
Tumori benigne colon: polipii
Polip unic/Polipoza multipla (transmitere ereditara dominanta);
$indroame ce asocia:a polipo:a intestinala. $indroame ce asocia:a polipo:a intestinala.
- Peutz-Jeghers pigmentarea tegumentelor si mucoaselor;
- Gardner osteoame multiple;
- Turcot tumori SNC;
- Cronkite-Canada anomalii ectodermale;
Diagnostic Diagnostic: clisma baritata (contrast simplu/dublu contrast)
colonoscopie;
Caractere radiologice:
- sesil (cu baza larga)/pediculat;
- deIecte de umplere (lacune) rotunde, contur net, inconjurate de
un lizereu opac;
Potential de malignitate:
- dimensiuni: 0,5 cm - rar malign;
- pedicul bine deIinit: potential scazut;
- conturul de supraIata: reticular, ulceratie - potential crescut de
malignitate;
- rata cresterii;
POLIPI PEDICULATI POLIPI PEDICULATI
1a
1b
2a
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file again. !f the red x still appears, you may have to delete the image and then insert it again.
Malignizare redusa
Aspect Iibroendoscopic
Aspect anatomo-patol.
POLIPI SESILI
Malignizare>50 Malignizare>50
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Aspect
endoscopic
POLIPI VILO$I
Malignizare foarte frecventa
Aspect endoscopic
MALIGNIZAREA POLIPULUI MALIGNIZAREA POLIPULUI
9 ANI DUPA EXTIRPARE ENDOSCOPICA
POLIPOZA COLONICA FAMILIALA POLIPOZA COLONICA FAMILIALA
POLIPOZA FAMILIAL MULTIPL
i mage and then insert it again.
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the file again. !f the red x still appears, you may have to delete the image and then insert it again.
a
a, b - aspect radiologic
c, d - aspect colonoscopic
e - specimen de rezec(ie
CANCERUL RECTO-COLONIC
Factori favorizanti:
- regim alimentar, RCUH, boala Crohn, polipoza Iamiliala,
iradierea pelvina;
Histologie:
- adenocarcinoame, rar tumori carcinoide, limIoame;
Forme macroscopice:
- Iorme vegetante, ulcerante, inIiltrante, mixte;
MORFOLOGIA CANCERULUI COLO-RECTAL:
clasificarea lezionala anatomo-patologica
BORMANN I
BORMANN II
BORMANN III
BORMANN IV
vegetant
Ulcerant pe
vegetatie
Ulcerant pe
infiltratie
Infiltant
difuzschir
longitudinal
transversal
DIACAOS1ICUL IMACIS1IC DIACAOS1ICUL IMACIS1IC
RADIOGRAFIA STANDARD>IN OCLUZIE; RADIOGRAFIA STANDARD>IN OCLUZIE;
CLISMA CLISMABARITATA BARITATACU CU DUBLU DUBLU CONTRAST CONTRAST; ;
ECOGRAFIA ECOGRAFIA; ; ENDOSONOGRAFIA ENDOSONOGRAFIA; ;
CT CT; ; COLONOSCOPIA COLONOSCOPIAVIRTUALA VIRTUALACT CT; ;
IRM IRM; ;COLONOSCOPIA COLONOSCOPIAVIRTUALA VIRTUALAIRM IRM; ;
CLISMA BARI1A1A CLISMA BARI1A1A
ASPEC1E ASPEC1E SEMEIOLOCI SEMEIOLOCICE CE
- inIiltratie: rigiditate parietala absenta distensiei colice;
- lacuna: dimensiuni variate, contur policiclic anIractuos, semiton
(Iorma vegetanta);
- nisa maligna (nisa in lacuna);
- stenoze: lungime variata, contur neregulat (Iorma vegetanta) sau
caracter regulat (Iorma inIiltranta);
- stop complet al progresiei contrastului, precedat de imagine de
stenoza/ oprire cu contur neregulat (mularea polului tumoral);
CANCER CANCER
INCIPIENT (T1) INCIPIENT (T1)
TIP INFILTRATIV TIP INFILTRATIV
(dublu contrast) (dublu contrast)
Rad/Imag.-Iasi-2003
Vegetant/polipoid:BORMANN I
CANCER COLONIC:TIPURI SEMEIOLOGICE
Ulcerant pe vegetant:BORMANN II
Tehnica:dublu contrast
again.
CANCER COLON:SEMEIOLOGIE IMAGISTICA
Tumora vegetanta-ulcerata tip BORMANN II
Piesa de rezectie
Ulcerant pe vegetatie:
BORMANN II
CANCER COLON DESCENDENT: CANCER COLON DESCENDENT:
FORMA VEGETANTA (lacuna) FORMA VEGETANTA (lacuna)
Infiltrant difuz >schir
BORMANN IV
'cotor de mr
CANCER ULCERANT: CANCER ULCERANT:
nisa in lacuna BORMAN II nisa in lacuna BORMAN II
CANCERE AVANSATE LOCO CANCERE AVANSATE LOCO- -REGIONAL, STENOTIC REGIONAL, STENOTIC
RECTAL RECTAL
RECTO RECTO- -SIGMOIDIAN SIGMOIDIAN
CANCER CANCER
MIXT, MIXT,
COLON COLON
TRANSVERS TRANSVERS
Rad/Imag.-Iasi-2003
red x still appears, you may have to del ete the image and then insert it again.
CANCERE DE CEC VEGETANTE/STENOZANTE CANCERE DE CEC VEGETANTE/STENOZANTE
Rad/Imag.-Iasi-2003
CANCER SIGMOIDIAN: CANCER SIGMOIDIAN: STOP STOP
TOTAL TOTAL AL COLOANEI BARITATE AL COLOANEI BARITATE
CANCER VEGETANT CANCER VEGETANT
CECAL CECAL - - INVAGINATIE INVAGINATIE
Complicatii:
- sindrom obstructiv;
- perIoratie (abces pericolic, Iistule);
Diagnostic diferential: Diagnostic diferential:
- spasm local segmentar;
- aderente;
- stenoze benigne; stenoze post-radice;
Extensie loco-regionala:
- eco-endoscopia;
- examinarea CT si IRM;
Extensie metastatica:
- ecograIie hepatica;
- examinare CT/IRM abdominala;
T
ENDOSONOGRAFIE RECTALA (6,5 Mhz): cancer rectal T-1
EVALUAREA EXTENZIEI LOCO-REGIONALE
TUMORA
Musc.mucosae
submucoasa
mucoasa
IRM,ANTENA ENDORECTALA:cancer incipient ( pT-1)
CT:CANCER COLON DREPT-extenzie regionala (T-4)
Rad/Imag.-Iasi-2003
COLONOGRAFIE & ENDOSCOPIE VIRTUALA CT
POLIP:Vedere 3D endoluminala si in sectiuni axiale
Aspect endoscopic
Vedere pe sectiune
ENDO VIRTUALA
Rad/Imag.-Iasi-2003
Radiografia abdominala simpla
Tehnica:
- decubit dorsal, raza verticala;
- ortostatism, decubit lateral (raza orizontala): abdomen acut
(perIoratie, ocluzie);
Semeiologie radiologica:
magini de tonalitate calcara. magini de tonalitate calcara.
- calciIicari condro-costale, suprarenaliene, pancreatice, arteriale
(aorta, iliace, splenica), ggl. mezenterici, Iibrom uterin, Ileboliti;
- calculi veziculari, calculi calciIicari urinari (coraliIorm, caliciali,
ureter, vezicali), vezica calciIicata, prostatice, calculi in Wirsung, chist
hidatic calciIicat;
Rad/Imag.-Iasi-2003
RADIOCRAFIA ABDOMIAALA S1AADARD RADIOCRAFIA ABDOMIAALA S1AADARD
Imagini de tonalitate hidrica Imagini de tonalitate hidrica
- hepatomegalie, splenomegalie, hipertroIie renala;
- tumori: suprarenaliene, retroperitoneale, renale;
Jiscere continind lichid: Jiscere continind lichid:
- glob vezical;
- stomac post-prandial;
- intestin subtire si colon (v. ocluzii intestinale)
Rad/Imag.-Iasi-2003
OCLUZII INTESTINALE
Etiologie:
- mecanica mecanica (obturarea lumenului digestiv);
- - functionala functionala (disparitia peristaltismului)
Examenul imagistic Examenul imagistic (Rg. abdominala, US, CT) (Rg. abdominala, US, CT) intrebari intrebari:
1. Este ocluzie ocluzie ? (-~ prezenta nivelelor hidro-aerice);
2. Este mecanica/Iunctionala mecanica/Iunctionala? (-~distensie inaintea obstructiei/
distensia intregului tract digestiv)
3. 3. Sediul Sediul obstructiei? (-~intestin/colon)
4. 4. Cauza Cauza obstructiei ? (aderente, tumora, invaginatie, volvulus)
5. Exista semne de strangulatie strangulatie? (-~ingrosarea peretelui ansei)
Rad/Imag.-Iasi-2003
OCLUZIA INTESTINULUI SUBTIRE
Semne generale:
- bula ga:oasa bula ga:oasa; dispozitie: ax oblic intre hipocondrul sting si
Iosa iliaca dreapta;
- - arcul ga:os arcul ga:os (imagine 'in magnet);
- - imagine 'in retorta`, imagine 'in retorta`,
- dispo:itie, numar dispo:itie, numar: unica/multipla, in tot abdomenul; anse jejunale:
vertical ('tuburi de orga); anse ileale: orizontal( 'trepte de scara);
- pliuri vizibile (Iunctie de distensia ansei);
Etiologie:
- - strangulatie. strangulatie. imagini hidro-aerice IS vacuitate colon;
- - obstructii obstructii: ileus biliar (aerobilie);
- - invaginatii invaginatii: clisma baritata cu reIlux ceco-ileal: imagini 'in trident;
Rad/Imag.-Iasi-2003
OCLUZIE OCLUZIE
INTESTINALA INTESTINALA
INALTA: INALTA:
ASPECT DE ASPECT DE
~MAGNET ~MAGNET
Rad/Imag.-Iasi-2003
OCLUZIE INTESTINALA INALTA: NIVELE HIDROAERICE OCLUZIE INTESTINALA INALTA: NIVELE HIDROAERICE
~POTCOAVA ~POTCOAVA
~Trepte de scara ~Trepte de scara
Ocluziile colonului
Semne generale:
- - bula de ga:. bula de ga:. voluminoasa, inaltime ~ largime;
- - arcul ga:os arcul ga:os: volum ~ IS, numar redus/unic;
- - boseluri. boseluri. dilatatii haustrale;
- distantarea pliurilor: aparitia 'pliurilor de flexiune` 'pliurilor de flexiune` la cudura
anselor destinse;
Etiologie:
$trangulatie. $trangulatie.
- volvulusul sigmoidului: arc gazos voluminos, putin lichid, ocupa
intreg abdomenul;
- volvulusul cecului: dilatarea aerica a cecului, uneori in pozitie para-
vertebrala stinga; vidarea Iosei iliace drepte;
Obstructie. Obstructie. tumorala;
VOLVULUS SIGMOIDIAN: VOLVULUS SIGMOIDIAN:
A)BULA DE GAZ SIGMOIDIANA; A)BULA DE GAZ SIGMOIDIANA;
A A
B) OCLUZIE 1OASA B) OCLUZIE 1OASA
DISTENSIE + NIVELE HIDRO DISTENSIE + NIVELE HIDRO- -
AERICE PE COLON AERICE PE COLON
B
Ocluzii functionale
Etiologie
- patologie urinara (colica, traumatisme renale, retentie acuta de
urina);
- colica biliara;
- pancreatita acuta, apendicita acuta, traumatisme abdominale;
- inIarctul miocardic;
Semne generale: Semne generale:
- absenta/raritatea nivelelor hidro-aerice;
- distensie aerica intestinala diIuza (gastrica, IS, colon, aer in rect);
Metode de explorare Metode de explorare: Rg abdominala (-~distensie); ecograIie
abdominala (-~absenta peristaltismului)
Rad/Imag.-Iasi-2003
Perforatiile tubului digestiv
Perforatie in peritoneu liber
Clasic: semiluna aerica subdiaIragmatica, vizibila pe rdgI. abdominala,
cu pacientul in ortostatism;
g. diferential g. diferential: sdr. Chilaiditi;
Perforatie cloazonata:
- examinare CT: aer extra-digestiv sediul perIoratiei (gastrica,
duodenala, sigmoidiana);
Examinare cu contrast:
- per os, retrograd;
- hidrosolubil; sediul perIoratiei;
Rad/Imag.-Iasi-2003
Ulcer duodenal perIorat: pneumoperitoneu pneumoperitoneu
Semiluna transparenta sub linia
diaIragmului,interpusa intre Iata
superioara a Iicatului si a
stomacului/splinei
Hemoragii digestive
Origine:
- superioara (eso-gastro-duodenala);
- inIerioara (IS, colon);
Exteriorizare: hematemeza/melena/rectoragii
ematemeza:algoritm de evaluare.
1. Fibroscopie: varice esoIagiene ulcer gastric/duodenal;
2. ArteriograIie: trunchi celiac, artera mezenterica superioara;
selectiv:artera gastro-duodenala, artera splenica;
3. Embolizare selectiva: microspirale;
Varice esoIagiene: TIPSS embolizare;
Melena/rectoragii:algoritm de explorare
- colonoscopie instrumentala si/sau virtuala CT/IRM;
- clisma baritata;
- arteriograIie : AMS, AMI; /- vasopresina;/- embolizare;
Infarctul intestinal
Etiologie:
- obstructie brutala (embolie, tromboza, disectie) a.mezenterica.
Diagnostic:
##adio adioggrafie rafie abdominala simpla. abdominala simpla.
- distensie aerica a IS; pneumatoza parietala;
Ecografia (limitata de distensia aerica). Ecografia (limitata de distensia aerica).
- Doppler pentru A Mez. Sup;
Examinarea CT. Examinarea CT.
- modiIicare parietala, diIerenta de captare a contrastului (segmente
ischemiate/segmente normale), ocluzia AMS (3D), perIoratie,
peritonita;
rteriografie rteriografie: selectiva (A.Mez.Sup.)/aortograIie;
Rad.Intervent.:cateterism selectiv ~ vasodilatatoare/ Iibrinolitice;
Rad/Imag.-Iasi-2003

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