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EVALUACIÓN RADIOLÓGICA

DEL TORAX

Dr. Paulo Puac


Residente I
Depto. Diagnóstico por Imágenes
Hospital Roosevelt
Abril 2011
•INTRODUCCION
•CONSIDERACIONES GENERALES
•ANATOMIA
•CONCLUSIONES
•INTRODUCCION
•CONSIDERACIONES GENERALES
•ANATOMIA
•CONCLUSIONES
• NOMBRE DEL PACIENTE
– Importante en pacientes críticos

• ORIENTACIÓN ADECUADA
– Identificación del paciente
• EVALUACIÓN DE LA TÉCNICA

– Penetración (4ta vertebra Torácica)

– Rotación (Posición de clavículas)

– Proyección
• AP (corazón grande, escapulas por dentro)
• PA (escapulas por fuera del parénquima pulmonar)

– Inspiración
• Adecuada (8-10 espacios intercostales posteriores)
• Mala inspiración (confusión con ICC)
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of Virginia Health
Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology.
University of Virginia Health Sciencies Center. Departament of
Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology.
University of Virginia Health Sciencies Center. Departament of
Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology.
University of Virginia Health Sciencies Center. Departament of
Radiology
PA AP

Daffner, Richard. Clinical Radiology. “The Essentials”. 2 ad. Ed.


Lippicont Williams and Wilkins. Pennsylvania. 2000
ESPIRACIÓN

INSPIRACIÓN

Daffner, Richard. Clinical Radiology. “The


Essentials”. 2 ad. Ed. Lippicont Williams and
Wilkins. Pennsylvania. 2000
• Radiografías portátiles
– Proyección AP
– Movimiento
– Rotación
– Redistribución de flujo
• Cefalización

• Estudios Previos
– Relación con el tiempo
– Lesiones nuevas
• Tiempo de evaluación
– 20 segundos
– Aumenta falsos positivos

• Orden de Evaluación

• “Uno solo ve lo que conoce”

• “Los mejores amigos son los estudios previos”


Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology.
University of Virginia Health Sciencies Center. Departament of
Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology.
University of Virginia Health Sciencies Center. Departament of
Radiology
Daffner, Richard. Clinical Radiology. “The Essentials”. 2 ad. Ed.
Lippicont Williams and Wilkins. Pennsylvania. 2000
•INTRODUCCION
•CONSIDERACIONES GENERALES
•ANATOMIA
•CONCLUSIONES
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology.
University of Virginia Health Sciencies Center. Departament of
Radiology
• Tráquea y Mediastino

• Corazón y Grandes Vasos

• Pulmones

• Pleura

• Angulo Costofrénico

• Diafragma

• Huesos y Tejidos Blandos


• Tráquea
– Línea Media
– Carina (T4-T5)
– Desviación de la línea media
• Tiroides
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of Virginia
Health Sciencies Center. Departament of Radiology
Daffner, Richard. Clinical Radiology. “The Essentials”. 2 ad. Ed.
Lippicont Williams and Wilkins. Pennsylvania. 2000
MEDIASTINO

– Región central del tórax

– Mediastino Anatómico

– Mediastino Radiológico

– Líneas Mediastinales

– Signo de la Silueta
MEDIASTINO ANATÓMICO

Daffner, Richard. Clinical Radiology. “The Essentials”. 2 ad. Ed.


Lippicont Williams and Wilkins. Pennsylvania. 2000
MEDIASTINO RADIOLÓGICO

Daffner, Richard. Clinical Radiology. “The Essentials”. 2 ad. Ed.


Lippicont Williams and Wilkins. Pennsylvania. 2000
LINEAS MEDIASTINALES

Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of


Virginia Health Sciencies Center. Departament of Radiology
SIGNO DE LA SILUETA

Daffner, Richard. Clinical Radiology. “The Essentials”. 2 ad. Ed.


Lippicont Williams and Wilkins. Pennsylvania. 2000
Daffner, Richard. Clinical Radiology. “The Essentials”. 2 ad. Ed.
Lippicont Williams and Wilkins. Pennsylvania. 2000
Daffner, Richard. Clinical Radiology. “The Essentials”. 2 ad. Ed.
Lippicont Williams and Wilkins. Pennsylvania. 2000
Daffner, Richard. Clinical Radiology. “The Essentials”. 2 ad. Ed.
Lippicont Williams and Wilkins. Pennsylvania. 2000
CORAZÓN Y GRANDES VASOS
• Índice Cardiotorácico
– Menor de 0.52
– Medible solo en PA

• Hilios Pulmonares
– Izquierdo mas alto (70%)
– Mismo nivel (30%)
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of Virginia
Health Sciencies Center. Departament of Radiology
Erkonen, William; Smith, Wilbur. Radilogia 101. 3era Ed. Lippicott
Williams and Wilkins. Barcelona 2010
PULMONES
– Lóbulos y Segmentos
– Unidad Funcional
• Acino Pulmonar
– Lobulillo Pulmonar Secundario
• 1 cm de Diámetro
• 3-5 Acinos
Daffner, Richard. Clinical Radiology. “The Essentials”. 2 ad. Ed.
Lippicont Williams and Wilkins. Pennsylvania. 2000
Daffner, Richard. Clinical Radiology. “The Essentials”. 2 ad. Ed.
Lippicont Williams and Wilkins. Pennsylvania. 2000
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
PULMONES

– Vasculatura Pulmonar
• Calibre
• Distribución
– Patrones Pulmonares
• Espacio Aéreo
• Intersticio
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
• DIAFRAGMA
– Forma de Cúpula
– Irregularidades en su superficie
– Derecho más alto
– Ángulos Costofrénicos
– Ánfulos Costodiafragmáticos
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of Virginia
Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of
Virginia Health Sciencies Center. Departament of Radiology
Spencen, Gay; Olazagasti, Juan. Introducction to Chest Radiology. University of Virginia
Health Sciencies Center. Departament of Radiology
•INTRODUCCION
•CONSIDERACIONES GENERALES
•ANATOMIA
•CONCLUSIONES
GRACIAS