CHISTUL HIDATIC PULMONAR

GENERALITATI
-Boala parazitara( intalnita la om si la n!l! animal! i!r"i#or!$% pro&sa prin &!z#oltar!a
tmorala #!zi'lara a lar#!i #i!rm!li '!sto&% taenia echinococcus la ni#!ll plamanli(
- Ca )r!'#!nta% !st! s!'n&ar '!li *!pati' iar 'a ori+in! !st! primiti#% ' ori+in!
&i+!sti#a( )( rar% !st! 'ons!'ti# '!li *!pati'$
- Ol &! t!ni! patrn&! in or+anism p! 'al! &i+!sti#a% ' !li"!rar!a !m"rionli
*!,a'ant prin s'ril! &i+!sti#! iar apoi% p! 'al!a #!n!i port! a-n+! in )i'at- priml
"ara-. lt!rior% p! 'al!a #!n!lor spra*!pati'!- #!na 'a#a- 'or& &r!pt- art!r! plmonar!
a-n+! in plamani ( al /-l!a "ara-$( O alta 'al! &! in)!star! o r!pr!zinta '!a a!riana

ANATOMIE PATOLOGICA
0 In t!stl plmonar% #!zi'la *i&ati'a !st! lo'alizata '!l mai a&!s!a in "az!l!
plmonar! si in sp!'ial in plamanl &r!pt(
0 C*istl !st! &! o"i'!i nilo'lar% )ormat &in m!m"rana !,t!rna (m( 'ti'lara%
p!rm!a"ila pt( mol!'l! mari si mi'ro"i$% m!m"rana proli+!ra- +!rminati#a( &a nast!r! la
#!zi'l!l! )ii'! si 'ontin! li'*i&l *i&ati'$(
0 M!m"rana !,t!rna ( 'ti'lara$%!st! &! +rosim! #aria"ila si s! 'onstit! pro+r!si#
prin &!nsi)i'ar!a par!n'*imli plmonar impins% ' o r!'ti! s'l!roasa 'ar! n p!rmit!
&!tasar!a !i &! plaman
ANATOMIE PATOLOGICA
0 Bron*iil! mi'i #or )i impins! &! '*ist in &!z#oltar!a sa. '!l! mi-lo'ii si mari snt
!ro&at!1 s!'tionat!% a!rl #!nin& in 'onta't ' m!m"rana !,t!rna a '*istli
0 2as!l! plmonar! pot )i 'omprimat! &! '*ist% ' aparitia &! #as! &! n!o)ormati!
in -rl '*istli '! pot pro#o'a *!moptizii
0 L!zinil! pl!ral! snt #aria"il!% r!pr!z!ntat! &! a&!r!nt! sa sim)iz! pl!ral!
( mai al!s in 'azl '*istrilor -,tapl!ral!$
0 In !#olti!% 'r!st!r!a '*istli poat! &!t!rmina ruperea in bronhii sau in cavitatea
pleurala; poat! supura ( pn!moni! sprata p!ri'*isti'a$% sa poat! muri ( se calcifica).
DIAGNOSTIC CLINC
0 Est! &i)!rit% )n'ti! &! !#olti!3 A(-'*ist in'*is. B(- '*ist *i&ati' &!s'*is spr!
!,t!rior
0 A(-Chist hidatic inchis- intr! &ata )i,arii !m"rionli in plaman si aparitia
prim!lor simptom! !,ista n int!r#al #aria"il ( lni% ani$( S!mnl &! &!"t !st! tusea
chintoasa% s'ata% ' expectoratii mucoase sau mucopurulente(
- Durerea toracica 4 apar! la ''a 516 &in "olna#i
-Hemoptizii mi'i% r!"!l! la tratam!nt in '*istri '!ntral!
- Reactii pleurale )!"ril!% &r!roas!
- Dispn!! mo&!rata% tranzitori!. r!a'tii al!r+i'! ( prrit% rti'ari!$
DIAGNOSTIC CLINIC II
0 Star!a +!n!rala poat! raman! mlt timp "na. s!mn!l! )izi'! snt mlt timp
#a+i37 p!r'ti!- matitat!
7 as'ltati!- ralri ron)lant!
sa m'oas!
Compli'atia '!a mai )r!'#!nta a '*istli *i&ati' plmonar !st! rptra a'!stia8
0 B(- Chist hidatic deschis ( complicat) p!ntr aparitia sa% n!'!sita pr!z!nta a / )a'tori
in&isp!nsa"ili3 pr!z!nta )istl!lor "ronsi'! si a in)!'ti!i in p!ri'*ist% !#!ntal si pr!z!nta
ni tramatism
DIAGNOSTIC CLINIC III
C*istl *i&ati' plmonar s! poat! &!s'*i&! in 3- "ronsii
- 'a#itat! pl!rala
- or+an! #!'in!
(!so)a+% int!stin % p!riton!$
Rptra in "ronsii &!t!rmina #omi'a *i&ati'a3 "rs'a% sr#!nita &pa n !)ort &! ts!
( in timpl n!i pn'tii !,ploratorii sa al ni !)ort )izi'$% insotita &! an,i!tat!( Pa'i!ntl
!#a'!aza li'*i& 'lar% a"n&!nt% amar-sarat% a&!s!a insotit &! san+!% ' )ra+m!nt! &!
m!m"ran! *i&ati'!(Un!ori% poat! im"ra'a asp!'tl n!i !,p!'toratii *i&ati'! '! &!#in!
rapi& prl!nta(
DIAGNOSTIC CLINIC I2
0 2omi'a poat! )i 'rati#a ( rar% ' #in&!'ar!a pa'i!ntli$ sa l!tala- prin
'ompli'atii m!'ani'! +ra#!% as)i,i!
- prin *!moptizi!
- so' ana)ila'ti' ' sin'opa
0In)!'tia '*istli s''!&! )r!'#!nt &!s'*i&!rii sal!% !,p!'toratiil! &!#!nin& prl!nt!% '
&!tritsri #!zi'lar!
E2OLUTIE % COMPLICATII
0 E#oltia !st! in 99: 'azri spr! 'ompli'atii% 'azril! #in&!'at! spontan )iin& o
!,'!pti!
0 Compli'atii mai )r!'#!nt! snt3 in)!'tii si1 sa *!mora+ii( Alt! 'ompli'atii in'l&
rptra in pl!ra ' aparitia ni piopn!motora,% rptra in !so)a+ (
0 C*istril! 'orti'al! parapl!ral! !#ol!aza o"isnit 'atr! sprati!% iar '!l!
'!ntral!% para"ronsi'! s! pot &!s'*i&! pr!'o'! in "ronsii
DIAGNOSTIC PARACLINIC
1. Intradermoreactia C!"#I 4 'onsta in in-!'tar!a intra&!rmi' &! anti+!n *i&ati'. !st!
poziti#a &a'a apar! pr!'o'! sa tar&i# (/;-;< *$ o papla1 ma'larosi! ' !&!m in -r
$. %ozinofilia- !st! 'r!s'ta (=-<:$. !ozino)ilia pro#o'ata% la 6-; zil! &pa IDR Casoni%
arata o 'r!st!r! p!st! ;: in '*ist! *i&ati'!
&. %xamenul sputei- in '*ist! *i&ati'! rpt! sa )israt! poat! arata r!stri &! m!m"rana%
#!zi'l! )ii'!% !t'
'. %xamenul Radiolo(ic- opa'itat! 'ar! in '*ist n!'ompli'at tr!"i! sa in&!plin!as'a
'on&itiil!3
0 Sa )i! omo+!na si "in! &!limitata &! r!stl par!n'*imli plmonar
0 Sa )i! &! tip li'*i&ian (prin int!rm!&il !i sa s! #a&a 'oast!l!$
0 Sa-si mo&i)i'! &iam!tr!l! in timpl mis'arilor r!spiratorii
Ima+inil! ra&iolo+i'! in '!l!lalt! sta&ii snt pato+nomoni'!3
- in sta&il &! pr!rptra% a!rl patrn&! p!ri'*isti' si apar! ima+in! &! > s!milna
'lara? la poll sp!rior al '*istli
- In sta&il &! rptra% apar! ima+in! *i&roa!ri'a n!t &!limitata. lt!rior% &pa
!#a'ar! apar! ima+in! 'a#itara ' p!r!ti )ini%"in! &!limitati% ' m!m"rana *i&ati'a
r!t!ntionata p! )n&l 'a#itatii
DIAGNOSTIC PARACLINIC
0 %co(rafia)m!to&a mo&!rna% &! mar! #aloar!
0 *omo(rafia computerizata- &ia+nosti' &! mar! pr!'izi!
0 %xamenul bronhoscopic + r!'oman&at in '*istl *i&@ti' 'ompli'at
DIAGNOSTIC DIAERENTIAL
0 C tmoril! "ron*o- plmonar! mali+n! primiti#! ( prin !,am!n CT% pn'ti!
transtora'i'a$
0 T"!r'loml 1 'a#!rna plina
0 Sar'oml plmonar (prin !,( 'itolo+i' spta% !,( "ron*os'opi'$
0 Tmori m!tastati'!
0 C*ist a!rian in)!'tat
0 Tmori "ron*o- plmonar! "!ni+n! (*amartom$
TRATAMENT
0 Est! '*irr+i'al% 'onstan& in sprimar!a parazitli si tratar!a l!zinilor "ron*o-
plmonar! &! #!'inatat!
0 In '*istl n!'ompli'at% s! pra'ti'a 3tora'otomi!% !#a'ar!a li'*i&li *i&ati' prin
pn'ti!% !#a'ar!a m!m"ran!i *i&ati'! % tratam!ntl lo-!i '*isti'! r!stant! (prin 'apitona-
' nBlon$
0 In '*istl 'ompli'at% sprat s! aso'iaza la#a-l 'a#itatii '*isti'! ' anti"ioti'
.r!z!'tia plmonara !st! in&i'ata &oar &a'a par!n'*iml plmonar !st! &istrs &!
sprati!( La )inal% s! aso'iaza &r!na-l 'a#itatii tora'i'!(
0 R!zltat!l! snt "n!% 'ompli'atiil! postop!ratorii (!mpi!m pl!ral% spratia
lo-!i '*isti'!% *!mora+ii% !'*ino'o''oza s!'n&ara$ )iin& rar!