Cudurada Habka Laabta ee Sawirka ogaanshaha

Anatomy Core

• U fiirso jiilka tracheal-bronchial geed, lobes, qaybaha, iyo jeexjeexyada. Ogsoonow lobule sambabada sare (1.5-2-cm) -cutubka shaqada aasaasiga ah ee sambabada ee lagu arkay HRCT. U fiirso qaab dhismeedka muhiimka ah ee meelaha alveolar-ka ah ee leh isgaarsiintu inta u dhaxaysa (daloolada Kohn & kanaalka Lambert) taas oo u oggolaanaysa in hawadu dhaqaaqdo isla habkana u oggolaanaya dareeraha dheecaanka ama transudative inuu ku faafo sambabada oo uu joogsado meesha dillaacsan. U fiirso anatomy ee sambabada: parietal oo ah qayb ka mid ah xuubka endothoracic iyo visceral ee sameeya cidhifka sambabada � meel bannaan oo u dhaxaysa.

• Mediastinum: waxaa ku hareeraysan sambabada iyo sambabada. Waxay dejisaa dhismayaal waaweyn oo ka kooban qanjidhada qanjidhada badan (eeg jaantuska muujinaya qanjidhada dhexe iyo ka-qaybgalkooda Lymphoma

Habka Guud ee Baarista Cabashooyinka Laabta

• Baaritaanka shucaaca (X-ray CXR); tallaabo 1 aad u fiican. Qiimaha jaban, soo-gaadhista shucaaca hooseeya, qiimaynta cabashooyinka caafimaad ee badan
• Sawirka CT: CT laabta, CT-xalinta sare (HRCT)
• Habka pathology-ga laabta:
• Qaxarka
• Caabuqa
• Neoplasms
• Bararka xiiq-dheerta
• Emphysema Pulmonary
• Xiriiriyaha
• Cudurka xuubka
• Mediastinum

PA & CXR dambe

• Aragtiyo dheeri ah ayaa la isticmaali karaa:
• Aragtida Lordotic: waxay ka caawisaa in la qiimeeyo gobollada apical
• Decubitus wuxuu u fiirsadaa midig iyo bidix: waxay ka caawisaa qiimaynta dheecaanka malabyarowga, pneumothorax iyo cudurrada kale

• CXR PA ee caadiga ah & aragtida dambe. Hubi soo-gaadhis wanaagsan: saxanadaha T-laf-dhabarta iyo weelasha wadnaha dhex mara ayaa lagu arki karaa aragtida PA. Tiri 9-10 feeraha dambe ee midig si aad u xaqiijiso dadaal dhiirigelin ku filan. Bilow sahan dhammaystiran adigoo isticmaalaya habkan: Ma jiraan dhaawacyo badan oo sambabada ah A-caloosha/diaphragm, darbiga T-thorax, M-mediastinum, L-sanbabada si gaar ah, sambabada-labadaba. Samee qaab raadin wanaagsan

• 1) Cudurka hawada hawada ee loo yaqaan alveolar lung disease? Buuxinta alveoli ee sambabada, acini iyo ka dibna labka oo dhan oo leh dareere ama walax kasta oo ka kooban (dhiig, malax, biyo, walxo borotiin ah ama xitaa unugyo) Radiographically: lobar ama qaybinta qaybinta, nodules hawada hawada ayaa laga yaabaa in la xuso, u janjeera in ay coalesce, hawada. bronchograms iyo calaamad silhouette ayaa jooga. Qaybinta (balanbaalista) lagu xusay (CHF). Si degdeg ah isu beddela muddo, ie, korodh ama hoos u dhac (maalmo)
• 2) Cudurka interstitial: dhexgalka sambabada interstitium (alveoli septum, parenchyma sambabada, darbiyada maraakiibta, iwm) tusaale ahaan fayrasyada, bakteeriyada yaryar, protozoans. Sidoo kale galitaanka unugyada sida unugyada bararka/malignantiga ah (tusaale, lymphocytes) Waxaa loo soo bandhigay xoojinta interstitium sambabada oo leh qaab reticular, nodular, isku dhafan oo reticulonodular ah. Sababo kala duwan: barar cudurada korontadaCudurka sambabada fibrosing, cudurada sambabada shaqada, caabuqa fayras/mycoplasma, TB, sarcoidosis lymphoma/leukemia iyo kuwo kale oo badan.

• Aqoonsiga qaababka kala duwan ee cudurrada sambabada ayaa kaa caawin kara DDx. Curo vs. Isku-dubarid (bidix). U fiirso qaababka kala duwan ee cudurrada sambabada: cudurka hawada sida isku-darka lobar ee tilmaamaya oof-wareen, isku-ururinta fidsan ee tilmaamaysa bararka sambabada. Atelectasis (burburka iyo luminta mugga). Noocyada interstitial ee cudurada sambabada: reticular, nodular ama isku dhafan. SPN vs. Isku-dubarid fara badan (nodules) waxay u badan tahay inay matalaan metts infiltrates vs. septic infiltrates.

• A = intraparenchymal
• B = pleural
• C = extrapleura
• Aqoonso goobta muhiimka ah ee nabarrada laabta

• Calaamadaha muhiimka ah: Calaamadda silhouette: ka caawinta meelaynta iyo DDx. Tusaale: Sawirka hoose ee bidix: shucaaca sambabada midig, xagee ku yaalaa? Sax MM sababtoo ah xudduudaha wadnaha saxda ah ee ku dheggan labka dhexe ee midig lama arko (silhouetted) Hawada bronchograms: hawo ka kooban boronkiito/bronchioles oo ay ku wareegsan yihiin dareere

Chest Trauma

• Pneumothorax (PTX): hawo (gaas) ee bannaanka xuubka. Sababo badan. Dhibaatooyinka:
• PTX kacsanaan: korodhka joogtada ah ee hawada booska xuubka xuubka kaas oo si degdeg ah u cadaadiya mediastinum iyo sambabada si degdeg ah u yareeya soo noqoshada xididada wadnaha. Waxay noqon kartaa dhimasho haddii aan si degdeg ah loo daweyn
• Spontaneous PTX: asaasiga ah (30-40) gaar ahaan ragga dhaadheer, dhuuban Sababaha dheeraadka ah: Marfans syndrome, EDS, Homocystinuria, a - 1-antitrypsin deficiency. Secondary: pts ka weyn oo qaba cudurka parenchymal: neoplasms, abscess, emphysema , fibrosis sambabada iyo malabka, catamenial PTX d/t endometriosis iyo kuwa kale.
• pneumothorax naxdin leh: jeexjeexa sambabada, dhaawacyada aan fiicneyn, iatrogenic (tuubooyinka laabta, iwm.) acupuncture, iwm.
• CXR: note visceral pleural line aka sambabada geesta. Maqnaanshaha unugyada sambabada/mareenada sambabada ee ka baxsan xariiqda xuubka xuubka aragga. Pneumothorax qarsoon waa la seegi karaa. Marka la eego booska toosan, hawo ayaa kor u kacda iyo PTX waa in la raadiyaa meesha ugu sareysa.
• Jabka feeraha: v.common. Taxanaha feeraha ama fayraska (tusaale, mets, MM) Taxanaha feeraha x - fallaadho faa'iido badan ma leh sababtoo ah CXR iyo/ama iskaanka CT ayaa aad uga muhimsan in la qiimeeyo PTX ka dib (bidix bidix) dillaacsanaanta sambabada iyo waddo kale oo weyn.

Caabuqa

• Oof wareenka: bakteeriyada vs. fayraska ama fangas ama ku jira martida difaaca difaaca (tusaale, Cryptococcus in HIV/AIDS) TB sambabada

• Oof-wareen: beesha-helay vs. cusbitaal-helay. Bakteeriyada oof wareenka caadiga ah ama Lobar (aan ahayn qayb ka mid ah) oof wareenka oo wata walax suuf ah oo buuxinaysa alveoli kuna faafta dhammaan lobeska. M/C noolaha Streptococcus oof wareenka ama pneumococcus
• Kuwo kale: (Staph, Pseudomonas, Klebsiella esp. ee khamriga leh oo u horseedi kara necroSIS/gangrene sambabada) Mycoplasma (20-30s) aka sambabada socodka, iwm.
• Kiliinik ahaan: qufac wax soo saar leh, qandho, laabta xanuunka pleuritic mararka qaarkood hemoptysis.
• CXR: madhnaanshiyaha hawada isku-darka ah oo ku kooban dhammaan laabka. Bronchograms hawada. Calaamadda silhouette waxay caawisaa goobta.
• Viral: Hargabka, VZV, HSV, EBV, RSV, iwm. waxay soo bandhigtaa sida cudur sambabada interstitial oo noqon kara laba geesood. Waxaa laga yaabaa inay u horseeddo tanaasul xagga neefsiga ah
• Oof wareenka aan caadiga ahayn iyo Fungal Pneumonia: Mycoplasma, cudurka Legionnaire, iyo qaar ka mid ah fungal/Cryptococcus pneumonia ayaa laga yaabaa inay la socdaan cudur sambabada interstitial.
• Nabarka sambabada: ururinta caabuqa ee walxaha purulent ee sambabada oo inta badan necrotizes. Waxa laga yaabaa inay u horseeddo dhibaatooyin xagga sambabada iyo hab-dhiska oo weyn/nafta halis gelisa.
• On CXR ama CT: ururin wareeg ah oo leh xuduudo dhumuc weyn leh iyo necrosis dhexe oo ka kooban heerka dareeraha hawada. DDx oo ka yimaadda empyema oo qalloocisa sambabada iyo xuubka xuubka
• Rx: antibiyootik, antifungal, wakiilada fayraska.
• Oof wareenka wuxuu u baahan yahay in lagu daba galo ku celcelinta CXR si loo hubiyo xallinta dhamaystiran
• La'aanta hagaajinta shucaaca ee oof-wareenka waxay u taagan tahay difaaca oo hoos u dhacay, iska caabbinta antibiyootiga, kansarka sanbabada hoose ama arrimo kale oo murugsan.

Qaaxada sambabada

• Caabuqa guud ee aduunka (wadamada aduunka 3aad). 1 ka mid ah 3dii qof ee adduunka oo dhan waxaa saameeya TB. Qaaxada waxaa keena Mycobacterium TB ama Mycobacterium Bovis. Bacillus intracellular. Macrophage ayaa door muhiim ah ka ciyaara.
• Qaaxada sambabada aasaasiga ah & TB-da aasaasiga ah kadib. Waxay u baahan tahay soo-gaadhis soo noqnoqda iyadoo la neefsanayo. Inta badan ciidamada difaaca jirka, caabuqa firfircooni ma horumaro
• Qaaxadu waxay soo bandhigtaa sida 1) oo uu nadiifiyo qofka martida loo yahay, 2) oo lagu cadaadiyo Caabuqa Qaaxada Daahsoon (LTBI) 3) wuxuu keenaa cudur firfircoon oo TB. Bukaanka qaba LTBI ma fidiyaan TB.
• Sawirka: CXR, HRCT. Qaaxada aasaasiga ah: isku-darka hawada sambabada (60%) laf-dhabarta hoose, lymphadenopathy (95% - hilar & paratracheal), xuubka xuubka (10%). Faafitaanka Qaaxada aasaasiga ah waxay u badan tahay inay ku dhacaan kuwa difaaca jirran iyo carruurta.
• TB-da Milliary: faafinta dhibka sambabada iyo habdhiska oo keeni karta dhimasho
• Infekshanka dib-u-dhaqaajinta dugsiga hoose (sare) ama dib-u-kicinta: Inta badan Apices iyo qaybaha dambe ee nabarrada sare) PO2 sare, 40% - nabarada cavitating, barar ama cudur hawada isku dhafan, fibrocalcific. Tilmaamaha qarsoon: calcifications nodal.
• Dx: Bacilli acid-degdega ah (AFB) smear iyo dhaqanka (xaakada). Seerology HIV ee dhammaan bukaannada qaba tiibayda iyo heerka HIV aan la garanayn
• Rx: 4-daawoyinka: isoniazid, rifampin, pyrazinamide, iyo midkood ethambutol ama streptomycin.

Neoplasms sambabada (kansar sambabada aasaasiga ah vs. metastasis sambabada)

• Kansarka sambabada: m/c kansarka ragga iyo 6-aad ee kansarka ugu badan ee haweenka. Xiriir adag oo la leh neefsashada kansarka. Kiliinik ahaan: hel goor dambe, taas oo ku xidhan meesha burodu taal. Pathology (noocyada): Unugyada yaryar (SCC) vs. Kansarka unugyada aan yareyn
• Unug yar: (20%) waxay ka soo baxaan unugyada neuroendocrine aka Kultchitsky, sidaas awgeed waxaa laga yaabaa inay qariyaan walxo bayooloji ahaan firfircoon oo soo bandhigaya xanuunka 'paraneoplastic syndrome'. Caadi ahaan waxay ku taal badhtamaha (95%) ee ama u dhow sagxadda dhexe/labarka bronchus. Badankoodu waxay muujinayaan saadaal xumo oo aan la sixin karin.
• Unug aan yareyn: adenocarcinoma sambabada (40%) (M/C kansarka sanbabada), M/C ee haweenka iyo kuwa aan sigaarka cabbin. Kuwo kale: Unug-squamous-ka (waxaa laga yaabaa inay la socdaan nabar cakiran), unug weyn iyo qaar kale
• Filim cad (CXR): dhaawac cusub ama weynaaday, mediastinum balaartay oo soo jeedinaysa ka qayb qaadashada qanjidhada xuubka, dheecaanka xuubka, atelectasis, iyo xoojinta. SPN-waxaa laga yaabaa inay u taagan tahay kansarka sanbabada ee suurtagalka ah gaar ahaan haddii ay ka kooban tahay xudduudaha aan joogtada ahayn, weelasha quudinta, darbiga qaro weyn, ee sambabada sare. Nodules sambabada oo badan ayaa laga yaabaa inay matalaan metastasis.
• Habka ugu Fiican: HRCT oo ka duwan.
• Neoplasms laabta kale: Lymphoma waa v. ku badan laabta gaar ahaan qoraalada naasaha dhex dhexaadinta iyo gudaha.
• Guud ahaan M/C neoplasms sambabada waa metastasis. Burooyinka qaarkood waxay muujinayaan u-hortaag sare oo loogu talagalay sambabada sambabada, tusaale ahaan, Melanoma, laakiin kansar kasta wuxuu u soo bixi karaa sambabada. Meesha qaar ayaa loo yaqaan �Cannonball� metastasis
• Rx: shucaac, kiimoterabi, dib u soo celin

• Bararka sambabada: erey guud ayaa qeexaya ururinta dareeraha aan caadiga ahayn ee ka baxsan dhismayaasha xididada. Si balaadhan loogu qaybiyey Cardiogenic (tusaale, CHF, mitral regurgitation) iyo non-cardiogenic oo leh sababo badan (tusaale, dareere xad dhaaf ah, shubid ka dib, sababaha neerfaha, ARDS, qarqashada/xiirid u dhow, qiyaasta heroin-ka, iyo kuwa kale)
• Sababaha: korodhka cadaadiska Hydrostatic vs. hoos u dhaca cadaadiska oncotic.
• Sawirka: CXR iyo CT: 2-nooc daadka dhexmara iyo Alveolar. Soo bandhigida sawirku waxay kuxirantahay marxaladaha
• Gudaha CHF: Marxaladda 1: Dib-u-qaybinta socodka xididdada dhiigga (10-18-mm Hg) ee loo aqoonsaday sida �cephalization� ee xididdada sambabada. Marxaladda 2: bararka interstitial (18-25-mm Hg) bararka interstitial: xuubka xuubka, khadadka Kerley (lymphatics oo dareere ka buuxo) khadadka A, B, C. Marxaladda 3: bararka alveolar: cudurka hawada sare: isugaynta balastar ee ka dhalanaysa cudur hawada hawada kala firdhisan: bararka bararka, hawada bronchograms
• Rx: 3 yoolalka ugu muhiimsan: O2 hore si loo ilaaliyo O2 90% saturation
• Xiga: (1) hoos u dhigista soo noqoshada xididada sambabada (hoos u dhigista hore), (2) hoos u dhigista iska caabbinta xididdada dhiigga (yaraynta ka dib), iyo (3) taageerada inotropic. Daawo sababaha hoose (tusaale, CHF)

• Atelectasis sambabada: balaadhinta aan dhamaystirnayn ee parenchyma sambabada. Erayga "sambabada dumay" waxa caadiyan loo hayaa marka sambabada oo dhami ay dunto
• 1).
• 2) Atelectasis Passive (nasasho) waxay dhacdaa marka xiriirka ka dhexeeya xuubka parietal iyo visceral pleura uu xumaado (xuubka pleural effusion & pneumothorax)
• 3) Atelectasis Compressive waxay ku dhacdaa natiijadu tahay nabar kasta oo meel bannaan oo dhuunta ku jira oo cadaadis saaraya sambabada oo ku qasbaya hawada alveoli
• 4) Cicatricial atelectasis: waxay ku dhacdaa natiijada nabarrada ama fibrosis ee yareeya fidinta sambabada sida cudurada granulomatous, necrotizing oof-wareen, iyo fibrosis shucaaca.
• 5) Atelectasis sambabada xabagta waxay ka timaadaa yaraanta dusha sare iyo burburka alveolar
• 6) Plate-like ama discoid oo badanaa soo baxa ka dib marka la suuxiyo guud
• 7) Tilmaamaha sawirka: sambabada oo burburay, guuritaanka sambabada sanbabada, leexashada mediastinum, kor u kaca diaphragm, sicir-bararka sambabada ku dhow

• Mediastinum: pathology waxaa loo qaybin karaa kuwa keena cufnaanta xad-dhaafka ah ama kuwa keena cudurrada faafa ee ku lug leh mediastinum. Intaa waxaa dheer, hawadu waxay la socon kartaa mediastinum ee pneumomediastinum. Aqoonta anatomy mediastinal waxay caawisaa Dx.
• Baaxadaha dhexe ee hore: thyroid, thymus, teratoma/ burooyinka unugyada jeermiska, lymphoma, lymphadenopathy, kor u kaca aneurysms aortic
• Baaxadaha dhexe ee dhexe: lymphadenopathy, xididdada dhiigga, nabarrada bronki, iwm.
• Baaxadaha dhexe ee dhexe: burooyinka neurogenic, aneurysms aortic aneurysms, cufnaanta hunguriga, cufnaanta laf dhabarta, adenopathy silsilad aortic

• Emphysema sambabada: luminta unug laastikada caadiga ah/laastikada sambabada oo burburay xididada iyo septum alveolar / interstitium.
• Burburka parenchyma sambabada sababtoo ah barar dabadheeraad ah. Burburinta elastin-ku-dhex-dhexaadineed. Qabashada hawada/ balaadhinta hawada, sicir-bararka, dhiig-karka sambabada, iyo isbeddellada kale. Clinical: dyspnea horumarsan, aan laga noqon karin. Waqtiga mugga dhicitaanka qasabka ah ee 1 ilbiriqsi (FEV1) uu hoos ugu dhacay 50% bukaanku waa neefsanayaa marka uu dadaal yar sameeyo wuxuuna la qabsado qaab nololeedka.
• COPD waa sababta saddexaad ee ugu badan ee dhimashada adduunka. Waxay saamaysaa 1.4% dadka waaweyn ee Maraykanka. M:F = 1: 0.9. Pts 45 jir iyo ka weyn
• Sababaha: Sigaarka iyo a-1-Antitrypsin yaraanta (oo loo qaybiyo centrilobular (sigaar) iyo panacinar.
• Sawirka; calaamadaha sicir-bararka, hawo-ku-qabsiga, bulla, dhiig-karka sambabada.