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6.pulmonary edema and ards
- 1. 1 CHAN OAN HNH ANH PHU PHOI CAP VA HOI CHNG NGUY CAP HO HAP NGI LN BS.NGUYEN QUY KHOANG BS.NGUYEN QUANG TRONG
- 2. 2 DAN BAI Nha辰p 単e. Be辰nh ly湛 phe叩 nang lan to短a. X quang Phu淡 pho奪i ca叩p. X quang Ho辰i ch旦湛ng nguy ca叩p ho但 ha叩p 担短 ng旦担淡i l担湛n. Sinh ly湛 be辰nh cu短a Phu淡 pho奪i ca叩p va淡 ARDS. To湛m ta辿t.
- 3. 3 NHAP E Phu淡 pho奪i ca叩p (Acute pulmonary edema) va淡 Ho辰i ch旦湛ng nguy ca叩p 担短 ng旦担淡i l担湛n (Adult respiratory distress syndrome- ARDS) la淡 hai be辰nh ly湛 th旦担淡ng ga谷p ta誰i ca湛c pho淡ng Sa棚n so湛c 単a谷c bie辰t va淡 Hoi s旦湛c ngoa誰i. Co湛 nh旦探ng da叩u hie辰u la但m sa淡ng va淡 X quang de達 la達n lo辰n.
- 4. NHAP E Bie奪n hie辰n ba竪ng s旦誰 tu誰 d嘆ch trong ca湛c phe叩 nang mo辰t ca湛ch lan to短a. Phu淡 pho奪i ca叩p th旦担淡ng ga谷p h担n,tie但n l旦担誰ng kha短 quan ne叩u 単ieu tr嘆 s担湛m. ARDS hie叩m ga谷p h担n nh旦ng tie但n l旦担誰ng ra叩t xa叩u ma谷c du淡 co湛 単ieu tr嘆.
- 5. 5 BENH LY PHE NANG LAN TOA AC IEM CUA TON THNG PHE NANG Nhieu 単a湛m m担淡 ma辰t 単o辰 n旦担湛c,b担淡 kho但ng ro探, de達 ho辰i tu誰 v担湛i nhau. Co湛 kh鱈 a短nh no辰i phe叩 qua短n (air bronchogram) hoa谷c h狸nh ca湛nh b旦担湛m (Butterflys wings). Xo湛a m担淡 ca湛c ma誰ch ma湛u va淡 b担淡 tim. Th旦担淡ng thay 単o奪i nhanh theo th担淡i gian.
- 6. 6 KH ANH NOI PHE QUAN (AIR BRONCHOGRAM)
- 8. 8 VIEM PHOI (Co湛 air bronchogram)
- 9. Gi叩 tr畛 l畛n nh畉t m d畉u hi畛u ny em l, 坦 l khi c坦 Air bronchogram sign (+) th狸 ta c坦 th畛 kh畉ng 畛nh t畛n th藤董ng 畛 nhu m担 沿鞄畛i, lo畉i tr畛 t畛n th藤董ng c坦 ngu畛n g畛c t畛 mng 沿鞄畛i, t畛 thnh ng畛c, c滴ng nh藤 t畛 trung th畉t. D畉u hi畛u kh鱈 畉nh n畛i ph畉 qu畉n th藤畛ng g畉p nh畉t trong Vi棚m 沿鞄畛i, nh藤ng c滴ng c坦 th畛 g畉p trong c叩c b畛nh l箪 kh叩c nh藤 Ph湛 沿鞄畛i, Nh畛i m叩u 沿鞄畛i, th畉m ch鱈 c畉 trong b藤畛u 沿鞄畛i (bronchioloalveolar carcinoma, lymphoma).
- 10. Focal bronchiolo alveolar carcinoma
- 11. 11 BUTTERFLY WINGS (Pulmonary edema in a patient with acute left ventricular failure-ruptured papillary muscle).
- 12. 12 Ph湛 沿鞄畛i c畉p bi畛u hi畛n b畉ng h狸nh c叩nh b藤畛m ho畉c c叩nh d董i
- 13. 13 PULMONARY EDEMA / MITRAL STENOSIS AFTER TREATMENT
- 14. 14 BENH LY PHE NANG LAN TOA AC IEM CUA TON THNG PHE NANG Tre但n th旦誰c te叩,ca湛c to奪n th旦担ng phe叩 nang lan to短a th旦担淡ng kho但ng 単a谷c hie辰u cho mo辰t be辰nh ly湛 na淡o ca短. Ly湛 do la淡 co湛 nhieu cha叩t co湛 the奪 tra湛m 単ay ca湛c phe叩 nang nh旦:d嘆ch,ma湛u,mu短,protein,te叩 ba淡o
- 15. 15 BENH LY PHE NANG LAN TOA CAC NGUYEN NHAN CHNH 1/ Phu淡 pho奪i ca叩p do be辰nh ly湛 tim. 2/ Phu淡 pho奪i kho但ng do be辰nh tim. 3/ Ho辰i ch旦湛ng nguy ca叩p ho但 ha叩p 担短 ng旦担淡i l担湛n. 4/ Xu畉t huy畉t trong 沿鞄畛i (Cha叩n th旦担ng ng旦誰c lan to短a).
- 16. PH PH畛I C畉P DO SUY TIM TRI
- 18. 18 PHU PHOI TON THNG (INJURY PULMONARY EDEMA) MENDELSONS SYNDROME -Florid bilateral pulmonary edema secondary to aspiration of gastric contents. -Appearing within 24 hours of the incident. -The mortality is high.
- 19. Xu畉t huy畉t trong 沿鞄畛i
- 20. 20 BENH LY PHE NANG LAN TOA CAC NGUYEN NHAN CHNH 5/ Vie但m phe叩 qua短n pho奪i do nhie達m tru淡ng. 6/ B畛nh mng trong (Membrane hyaline) v B畛nh 畛ng protein trong phe叩 nang (proteinose alve湛olaire). 7/ Ung th旦 tie奪u phe叩 qua短n-phe叩 nang (cancer bronchiolo-alve湛olaire).
- 21. 21 D.Anthoine et al.LImagerie Thoracique.1996-1998. VIEM PHOI (Le湛gionellose)
- 22. 22 D.Anthoine et al.LImagerie Thoracique.1996-1998. BENH MANG TRONG
- 23. 23 D.Anthoine et al.LImagerie Thoracique.1996-1998. ONG PROTEIN PHE NANG
- 25. 25 K TIEU PHE QUAN-PHE NANG LAN TOA
- 26. 26 X QUANG PHU PHOI CAP Ha辰u qua短 cu短a s旦誰 旦湛 d嘆ch trong mo但 ke探 cu短a pho奪i,va淡 ne叩u na谷ng h担n th狸 d嘆ch tra淡n va淡o phe叩 nang. H狸nh X quang cu短a phu淡 pho奪i tu淡y thuo辰c va淡o m旦湛c 単o辰 d嘆ch na淡y:thay 単o奪i t旦淡 h狸nh m担淡 ma淡u k鱈nh 単u誰c cho 単e叩n h狸nh 単u誰c da誰ng ca湛nh b旦担湛m. Nguye但n nha但n co湛 the奪 do tim hoa谷c kho但ng do tim.
- 27. 27 X QUANG PHU PHOI CAP PHU PHOI DO NGUYEN NHAN TIM (CARDIOGENIC PULMONARY EDEMA) Chu短 ye叩u do Suy tim tra湛i. Bie奪u hie辰n s担湛m tre但n X quang la淡 s旦誰 ta湛i pha但n pho叩i ma誰ch ma湛u pho奪i le但n thu淡y tre但n hai pho奪i. Ne叩u Suy tim tra湛i tie叩p die達n,ta se探 tha叩y ma誰ch ma湛u pho奪i m担淡 do d嘆ch tha叩m quanh ma誰ch ma湛u, ke淡m theo la淡 ca湛c 単旦担淡ng Kerley.
- 28. HNH 畉NH M畉T KNH M畛 (GROUND-GLASS PATTERN) G畛i l h狸nh 畉nh m畉t k鱈nh m畛 khi c坦 s畛 gia tng 畉m 畛 nhu m担 沿鞄畛i, trong khi v畉n th畉y r探 b畛 m畉ch m叩u v ph畉 qu畉n. H狸nh 畉nh m畉t k鱈nh m畛 c坦 khi k畉t h畛p v畛i d畉u hi畛u kh鱈 畉nh n畛i ph畉 qu畉n (air bronchogram). C畉n ph畉i ph但n bi畛t v畛i 担ng 畉c 沿鞄畛i (consolidation): b畛 m畉ch m叩u-ph畉 qu畉n b畛 xo叩. 但y l h狸nh 畉nh th藤畛ng g畉p nh藤ng kh担ng 畉c hi畛u, th藤畛ng g畉p 畛 xu畉t huy畉t 沿鞄畛i (pulmonary hemorrhage), ph湛 沿鞄畛i (pulmonary edema), vi棚m 沿鞄畛i.
- 29. 29 BONG M KNH UC (GROUND-GLASS OPACITY)
- 31. 31 VIEM PHOI NHA NONG (Poumon de fermier)
- 32. HYPERSENSITIVITY PNEUNONITIS (TR蕩畛C V SAU i畛U TR畛 B畉NG CORTISTEROID)
- 33. 33 PHU PHOI DO NGUYEN NHAN TIM (CARDIOGENIC PULMONARY EDEMA) PULMONARY EDEMA / MITRAL STENOSIS AFTER TREATMENT
- 34. 34 X QUANG PHU PHOI CAP PHU PHOI DO NGUYEN NHAN TIM (CARDIOGENIC PULMONARY EDEMA) Na谷ng h担n,ta se探 tha叩y tu誰 d嘆ch trong ca湛c chu淡m phe叩 nang 担短 hai 単a湛y pho奪i,roi tu誰 d嘆ch phe叩 nang quanh hai ro叩n pho奪i cho ra h狸nh ca湛nh b旦担湛m. Co湛 the奪 tra淡n d嘆ch ra探nh lie但n thu淡y,tra淡n d嘆ch ma淡ng pho奪i.
- 35. 35 Tu畉n hon 沿鞄畛i b狸nh th動畛ng T叩i ph但n ph畛i m畉ch m叩u 沿鞄畛i
- 36. 36 CARDIAC FAILURE -Enlarged heart size. -No clear heart border (interstitiel edema), Kerleys line, pleural effusion. -Redistribution.
- 37. 37
- 38. 38 Dy v叩ch li棚n ti畛u th湛y
- 39. 39 X QUANG PHU PHOI CAP PHU PHOI DO NGUYEN NHAN TIM (CARDIOGENIC PULMONARY EDEMA) DAU HIEU KHONG CHUYEN BIET DAU HIEU CHUYEN BIET 1.Phu淡 quanh tru誰c ma誰ch ma湛u-phe叩 qua短n. 2.Tra淡n d嘆ch ra探nh lie但n thu淡y. 3.Tra淡n d嘆ch ma淡ng pho奪i. 1.Ta湛i pha但n pho叩i ma誰ch ma湛u pho奪i. 2.Pha但n bo叩 h狸nh ca湛nh b旦担湛m. 3.旦担淡ng Kerley B.
- 40. 40 X QUANG PHU PHOI CAP PHU PHOI DO NGUYEN NHAN TIM (CARDIOGENIC PULMONARY EDEMA)
- 41. 41 X QUANG PHU PHOI CAP PHU PHOI DO NGUYEN NHAN TIM (CARDIOGENIC PULMONARY EDEMA) -Redistribution. -Diffuse bilateral interstitial edema. MYOCARDIAL INFARCTION TRANSVENOUS PACEMAKER -The lungs are now clear. -Normal pulmonary vasculature.
- 42. 42 X QUANG PHU PHOI CAP PHU PHOI DO NGUYEN NHAN TIM (CARDIOGENIC PULMONARY EDEMA) -Perihilar consolidation. -Cardiomegaly. LEFT HEART FAILURE
- 43. 43
- 44. 44 X QUANG PHU PHOI CAP PHU PHOI DO NGUYEN NHAN TIM (CARDIOGENIC PULMONARY EDEMA)
- 45. 45 X QUANG PHU PHOI CAP PHU PHOI KHONG DO NGUYEN NHAN TIM (NON CARDIOGENIC PULMONARY EDEMA) Nguye但n nha但n:co湛 nh旦探ng nguye但n nha但n nh旦:Ngo辰p n旦担湛c,Ure但 huye叩t cao,truyen d嘆ch qua湛 ta短i,ch畉n th藤董ng s畛 n達o Ca湛c nguye但n nha但n tre但n ga但y ta棚ng t鱈nh tha叩m tha淡nh ma誰ch va淡 thoa湛t d嘆ch va淡o phe叩 nang. H狸nh a短nh bo湛ng m担淡 phe叩 nang,th旦担淡ng co湛 h狸nh ca湛nh b旦担湛m trong khi bo湛ng tim b狸nh th旦担淡ng.
- 46. 46 X QUANG PHU PHOI CAP PHU PHOI KHONG DO NGUYEN NHAN TIM (NON CARDIOGENIC PULMONARY EDEMA) DROWNING -Bilateral basal air-space consolidation. -Normal heart size.
- 47. 47 X QUANG PHU PHOI CAP PHU PHOI KHONG DO NGUYEN NHAN TIM (NON CARDIOGENIC PULMONARY EDEMA) DROWNING -Asymmetric air-space consolidation. -Normal heart size.
- 48. 48 X QUANG PHU PHOI CAP PHU PHOI KHONG DO NGUYEN NHAN TIM (NON CARDIOGENIC PULMONARY EDEMA) -Diffuse air-space consolidation with air bronchograms. NEUROGENIC PUL.EDEMA HEAD TRAUMA INTRACRANIAL HEMORRAGE Wheezes and rales
- 49. 49 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) Khoa短ng 150.000 be辰nh nha但n/na棚m (担短 Hoa ky淡) v担湛i t旦短 vong # 60%. Ca湛c nguye但n nha但n nh旦:Nhie達m tru淡ng, ha誰 huye叩t a湛p,h鱈t ca湛c cha叩t 単o辰cco湛 the奪 la淡m to奪n th旦担ng no辰i ba淡o mao ma誰ch va淡 lie但n ba淡o phe叩 nang ga但y ne但n tie叩t d嘆ch va淡o phe叩 nang va淡 suy ho但 ha叩p na谷ng.
- 50. 50 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) Co湛 9 tie但u chua奪n cu短a PETTY 単e奪 cha奪n 単oa湛n ARDS,trong 単o湛 ne但n l旦u y湛: Kho但ng co湛 t狸nh tra誰ng Suy tim tra湛i hoa谷c COPD. Ap l旦誰c mao ma誰ch pho奪i <12mmHg. Co湛 t狸nh tra誰ng thie叩u O2, trong ma湛u tram tro誰ng:PaO2 50mmHg ma谷c du淡 be辰nh nha但n 単旦担誰c 単旦a O2 h鱈t va淡o FiO2 > 60%.
- 51. 51 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) DAU HIEU KHONG CHUYEN BIET DAU HIEU CHUYEN BIET 1.Kho但ng phu淡 quanh tru誰c ma誰ch ma湛u-phe叩 qua短n. 2.M担淡 ma淡u k鱈nh 単u誰c. 3.Kho但ng co湛 Tra淡n d嘆ch ma淡ng pho奪i. 1.Ma誰ch ma湛u pho奪i kho但ng gia探n to va淡 kho但ng 単a短o ng旦担誰c. 2.Phu淡 pho奪i ra短i ra湛c 担短 ngoa誰i bie但n. 3.Tim kho但ng to
- 52. 52 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA)
- 53. Peripheral and widespread airspace opacities in ARDS
- 54. 54 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) Th担淡i gian: 0-12 gi担淡X quang ng旦誰c b狸nh th旦担淡ng. 12-24 gi担淡Phu淡 pho奪i mo但 ke探 cho ra h狸nh m担淡 ma淡u k鱈nh 単u誰c. 24-48 gi担淡o但ng 単a谷c ca湛c chu淡m phe叩 nang,ra短i ra湛c chu短 ye叩u 担短 ngoa誰i bie但n. Kho但ng co湛 TDMP ne叩u kho但ng ke淡m bo辰i nhie達m pho奪i.
- 55. 55 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) Th担淡i gian: 5-7 nga淡yPhu淡 pho奪i bie叩n ma叩t t旦淡 t旦淡. o但ng 単a谷c t旦淡ng vu淡ng. > 7 nga淡yX担 ho湛a mo但 ke探.
- 56. 56 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) Cha奪n 単oa湛n pha但n bie辰t v担湛i Phu淡 pho奪i ca叩p ba竪ng: o a湛p sua叩t mao ma誰nh pho奪i b鱈t (PCWP) < 12mmHg. Hu湛t d嘆ch t旦淡 phe叩 qua短n (ARDS:protein > 50g/l.)
- 57. 57 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) ARDS in a patient who sustained severe injuries in a road traffic accident. -Peripheral air-space consolidation with air bronchograms. -Normal heart size.
- 58. 58 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) -Diffuse air-space consolidation with air bronchograms. -Normal heart size.
- 59. 59 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) -Peripheral air-space consolidation. -Normal heart size.
- 60. 60 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) -Peripheral air-space consolidation. -Normal heart size.
- 61. 61 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) -Peripheral air-space consolidation.
- 62. 62 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) -Consolidation with air bronchograms. -Some ground-glass opacities.
- 63. 63 B畛nh mng trong do thi畉u Surfactant
- 64. 64 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) DAY 1 DAY 5 DAY 7 SARS-SEVERE ACUTE RESPIRATORY SYNDROME
- 65. 65 SARS-SEVERE ACUTE RESPIRATORY SYNDROME 15/03/2003 19/03/2003 20/03/2003
- 66. 66 X QUANG ARDS PHU PHOI TON THNG (INJURY PULMONARY EDEMA) SARS DAY 3 DAY 5
- 67. 67 SINH LY BENH CUA PHU PHOI Co湛 3 ye叩u to叩 ch鱈nh: Ap sua叩t thu短y t坦nh (ASTT). Ap l旦誰c keo huye叩t t旦担ng (ALKHT). T鱈nh tha叩m mao ma誰ch (TTMM). Tr旦担湛c 単a但y,ng旦担淡i ta hay du淡ng ch旦探: ASTTPhu淡 pho奪i do tim. TTMMPhu淡 pho奪i kho但ng do tim.
- 68. 68 SINH LY BENH CUA PHU PHOI Nga淡y nay ne但n du淡ng: Phu淡 pho奪i tha叩m (Transudative pulmonary edema) do ASTT hoa谷c ALKHT va淡 ma淡ng mao ma誰ch co淡n nguye但n ve誰n ne但n protein kho但ng tha叩m qua 単旦担誰c. Phu淡 pho奪i tie叩t (Exudative pulmonary edema) do to奪n th旦担ng no辰i ma誰c mao ma誰ch va淡 bie奪u mo但 phe叩 nang va淡 TTMM ne但n protein va淡o 単旦担誰c phe叩 nang.
- 69. 69 SINH LY BENH CUA PHU PHOI
- 70. 70 SINH LY BENH CUA PHU PHOI D旦担湛i k鱈nh hie奪n vi quang ho誰c,co湛 h狸nh a短nh phu淡 va淡 tha但m nhie達m te叩 ba淡o cu短a va湛ch lie但n phe叩 nang va淡 khoa短ng ke探,単ong th担淡i co湛 xua叩t huye叩t mo但 ke探 va淡 phe叩 nang. Ngoa淡i vie辰c ma叩t ca湛c Phe叩 ba淡o type I, th狸 th旦担淡ng tha叩y ca短 t狸nh tra誰ng ta棚ng sa短n la達n loa誰n sa短n Phe叩 ba淡o type II.
- 71. 71 TOM TAT ALVEOLAR PUL.EDEMA ARDS 1.KERLEYS LINES Often present. Usually absent. 2.FISSURES Thickened. Normal. 3.EFFUSION Frequent,especially on the right side. Usually absent or small. 4.PULMONARY VESSELS Redistribution. Normal. 5.BRONCHIAL WALLS Cuffing. +/- Cuffing. 6.HEART SIZE Enlarged. Normal. 7.DISTRIBUTION Perihilar. Diffuse or peripheral. 8.VASCULAR PEDICLE Wide. Normal.
- 72. 72 TOM TAT ALVEOLAR PULMONARY EDEMA ADULT RESPIRATORY DISTRESS SYNDROME -Left heart failure. -Mitral valve disease. -Renal failure. -Overhydration. -Drowning. -Neurogenic. -Postembolic. -Sepsis. -Hypotension (VietNam lung,DaNang lung, shock lung). -O2 toxicity. -Noxious inhalation (includes cocaine). -Aspiration. -Embolism (air,fat,amniotic). -Pancreatitis. -Disseminated intravascular coagulation. -Virulent pneumonias (SARS,Avian flu).
- 73. 73 KET LUAN ALVEOLAR PULMONARY EDEMA ARDS (-) 1.To奪n th旦担ng no辰i ba淡o mao ma誰ch,lie但n ba淡o phe叩 nang. (+) >30mmHg 2.Ap l旦誰c mao ma誰ch pho奪i b鱈t. <12mmHg. <30g/l 3.D嘆ch trong phe叩 nang co湛 protein. >50g/l To叩t,de達 dieu tr嘆. 4.Tie但n l旦担誰ng. Xa叩u,kho湛 tri. (T旦短 vong 50-70%)
- 74. 74 XIN C畉M N QU V畛 THEO DI