Alveolar condensation syndrome

Transcription

1 Alveolar condensation syndrome Dr Etienne Leroy-Terquem Centre hospitalier de Meulan les Mureaux. France French-cambodian association for pneumology (OFCP)

2 Lobule: morphological unit. Dimension: 10 to 25 mm. It is composed of 3 to 5 acini (functional unit) (7.5 mm); 30 to 50 primary lobules (0.5 to 1 mm). 1 et 1 centrolobular bronchiol and artery; 2. terminal bronchiol and artery; 3. respiratory bronchiol; 4. canal; 5. sac; 6. alveolar; 7. perilobular vena and lymphatic vessels.

3 Features of alveolar syndrome Non-homogeneous Not well limited (except if there is contact with the fissura, then the consolidation is «systematised» Aeric bronchogram present or not No retraction in acute phase (but retraction is possible if chronic evolution)

4 Alveolar condensation

5 Systematised opacity with aeric bronchogram

6 Main etiologies of localised alveolar syndrome Acute Infections (bacterial, viral) Tuberculosis Lung infarct and embolism Lung traumatism Post radiotherapy (acute phase ) Mycosis Loeffler syndrome Alveolar sarcoïdosis Localised alveolar oedema Chronic Chronic pneumonia Chronic pneumonia with eosinophilia Bronchiolo-alveolar cancer Lymphoma and haemopathy Pseudolymphoma

7 Main etiologies of diffused alveolar syndrome Acute Infections (bacterial, viral, opportunistic) Tuberculosis, mycosis Traumatism (contusion, fat embolism) Angeitis Pulmonary haemorrhage Pulmonary oedema Loeffler syndrome, eosinophilic lung Hypersensibility pneumonia (allergic alveolitis) Chronic Diffuse bronchiolo-alveolar damage Lymphoma and haemopathy Sarcoidosis Pulmonary alveolar proteinosis Lipidic pneumonia desquamative intersticial pneumonia

8 Lobar pneumonia (strep. Pneumoniae)

9 Lobar right inferior pneumonia (strep. Pneumoniae)

10 One of the frequent etiologies of infectious pneumonia is ear-nose-throat and dental infections

11 Bifocal infection: external segment of right sup. lobe and left inf. lobe

12 Bifocal infection: right sup. lobe and right inf. lobe

13 cough, asthenia, loss of weight After 4 weeks AFB positive in sputum Tuberculosis pneumonia. Retractile evolution with treatment

14 HIV - HIV+ TB pneumonia aspects are not rare in countries with a high incidence of TB, in patients with AIDS and also in immuno-competent patients.

15 Man 30 years old HIV+ R.S. lobe pneumonia and hilar adenopathy AFB-x 3 in sputum Bronchial aspiration and BAL: AFB + Fistulised node on endoscopic view

16 Man 25 years old, weight, t 39 C, cough, AFB + in sputum Left alveolar opacity. Treatment: 2RHZE

17 Evolution after 2 months of RHZE Worsening after 2 months of treatment, with persistence of AFB + in sputum Antibiogram: BK resistant to R and H ( «MDR» TB). Modification of treatment with adaptation to the antibiogram: favourable retractile evolution

18 African officer in internship in France, t 39 C, stable condition,! no functional or respiratory signs! Excavated opacity of the inferior lobe, apical segment, AFB+

19 Pneumonia with aeric bronchogram Micro nodula caverna

20 Woman, 20years old, No resp. antecedents. Gradual respiratory failure with fever and severe hypoxemia. Chest x-ray on admission to the intensive care unit

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22 3 days later. Bronchial aspiration, AFB+.

23 Man, 50 years old, fever, cough, dyspnea, headache, abdominal pain. Worsening despite amoxicillin treatment Legionnaire s disease

24 Mycoplasma pneumonia (1)

25 Cure after treatment by erythromycin (2)

26 Man, 35 years old, dyspnea and severe hypoxemia. Treatment by amoxicilline 3 g per day. (1)

27 Worsening at J4. Modification of treatment and introduction of erythromicin IV 3g/24h. Improvement in few days: Mycoplasma pneumonia. (2)

28 Bronchiolo-alveolar carcinoma

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31 Pulmonary oedema One can distinguish 2 physiopathological types: The hemodynamic oedema, consequence of left ventricular failure, with pulmonary arterial hypertension, of post-capillar type. Medical treatment is usually effective (O2, diuretic, TNT..). There is no anatomic lesion of the «alveolo capillar barrier» The lesionnal oedema: the etiologies are varied (viral or bacterial), toxic (for exemple inhalation of toxic gases), or complication from shock, regardless of the cause. The prognosis is most often dismal. Death may occur by refractory hypoxemia. The alveolo-capillar barrier is more or less irreversibly altered.

32 Pulmonary cardiogenic oedema

33 Acute pulmonary oedema: «butterfly wings» image

34 Acute pulmonary oedema After furosemide

35 Acute pulmonary oedema. Notice the asymetry of the image.

36 Asymetric cardiogenic edema.

37 Woman, 7 and half months pregnant. Fever and dyspnea with rapid deterioration in few days. No improvement despite amoxicilline then erythromycin

38 Worsening at J2 then J3: lesionnal oedema probably with a viral origin.