ADEMHALING: LONGZIEKTEN
LIEVEN DUPONT
Inhoudsopgave
H1: DIAGNOSTISCHE METHODEN.....................................................................4
1. BEELDVORMING VAN DE THORAX.........................................................................................4
2. BELANGRIJKSTE RADIOLOGISCHE PATRONEN (CT / RX)............................................................4
3. MEDIASTINUM EN DIAFRAGMA.............................................................................................4
4. LONGPARENCHYM............................................................................................................. 4
5. LONGFUNCTIE – BASISBEGRIPPEN.........................................................................................5
6. BRONCHIALE HYPERREACTIVITEIT......................................................................................... 5
7. GASUITWISSELING & BLOEDGAS.......................................................................................... 6
8. ENDOSCOPIE & INVASIEVE DIAGNOSTIEK...............................................................................6
9. PATHOLOGISCHE BASISPRINCIPES.........................................................................................6
KERNTEKST VOOR EXAMEN:............................................................................................ 7
H2: RESPIRATOIRE INFECTIES.........................................................................8
2.1. BOVENSTE LUCHTWEGINFECTIES.......................................................................................8
2.2 ACUTE BRONCHIOLITIS................................................................................................... 10
2.3 ACUTE TRACHEOBRONCHITIS..................................................................................10
2.4 ACUTE COPD-EXACERBATIE (AECOPD).....................................................................11
2.5 COMMUNITY-ACQUIRED PNEUMONIA (CAP).............................................................11
2.7 TUBERCULOSE (TB).................................................................................................. 14
2.8 NIET-TUBERCULEUZE MYCOBACTERIËN (NTM)....................................................................16
2.9 LONGINFECTIES BIJ IMMUUNGEDEPRIMEERDEN.......................................................19
🔑 EXAMENVUISTREGELS............................................................................................... 20
H3: OBSTRUCTIEVE LONGAANDOENINGEN......................................................21
ASTMA BRONCHIALE.......................................................................................................... 21
pathofysiologie........................................................................................................... 21
kliniek......................................................................................................................... 23
Diagnose.................................................................................................................... 23
behandeling............................................................................................................... 25
COPD............................................................................................................................... 28
kliniek......................................................................................................................... 30
behandeling............................................................................................................... 34
astma vs COPD........................................................................................................... 35
BRONCHIECTASIEËN............................................................................................................. 36
pathofysiologie........................................................................................................... 36
etiologie..................................................................................................................... 39
diagnose..................................................................................................................... 39
BEHANDELING............................................................................................................ 40
H4: NEOPLASIEËN VAN LONG EN THORAX......................................................42
, LONGCARCINOOM / BRONCHUSCARCINOOM..............................................................................42
Etiologie / Risicofactoren...........................................................................................42
Pathogenese.............................................................................................................. 42
Pathologie / Typen...................................................................................................... 44
Kliniek........................................................................................................................ 44
Diagnose.................................................................................................................... 45
classificatie en stadiëring...........................................................................................46
Behandeling............................................................................................................... 49
KLEINCELLIG LONGCARCINOOM (SCLC)......................................................................52
ZELDZAME LONGTUMOREN.................................................................................................... 53
CARCINOÏD TUMOR..................................................................................................... 53
ANDERE ZELDZAME LONGTUMOREN..........................................................................54
OVERZICHT: NEURO-ENDOCRIENE LONGTUMOREN....................................................54
SOLITAIRE PULMONALE NODULUS (SPN).................................................................................55
LONGMETASTASEN.............................................................................................................. 57
Terminologie.............................................................................................................. 57
Klinische presentatie..................................................................................................57
Diagnose.................................................................................................................... 57
Behandeling: metastasectomie..................................................................................58
Chirurgische techniek................................................................................................. 58
Resultaten & overleving............................................................................................. 58
MEDIASTINALE TUMOREN..................................................................................................... 59
Kliniek........................................................................................................................ 59
Diagnose.................................................................................................................... 59
Indeling naar lokalisatie............................................................................................. 59
Tumoren per compartiment.......................................................................................60
Beleid......................................................................................................................... 61
PLEURALE TUMOREN........................................................................................................... 63
algemeen................................................................................................................... 63
Maligne pleuraal mesothelioom..................................................................................63
Benigne pleurale tumoren..........................................................................................64
Pleurale metastasen................................................................................................... 65
H5: INTERSTITIËLE LONGPATHOLOGIE...........................................................66
ALGEMEEN........................................................................................................................ 66
overzicht van ILD........................................................................................................ 66
Pathogenese.............................................................................................................. 70
Diagnose.................................................................................................................... 70
Behandeling............................................................................................................... 72
H6: PLEURA, THORAXWAND EN DIAFRAGMAPATHOLOGIE...............................73
TABEL.............................................................................................................................. 73
PNEUMOTHORAX................................................................................................................. 73
Typen......................................................................................................................... 73
Symptomen................................................................................................................ 73
Diagnostiek................................................................................................................ 74
Behandeling............................................................................................................... 74
AANGEBOREN AFWIJKINGEN VAN DE THORAXWAND....................................................................74
Pectus excavatum...................................................................................................... 74
Pectus carinatum....................................................................................................... 75
AANDOENINGEN VAN HET DIAFRAGMA.....................................................................................75
H8: SLAAP EN RESPIRATIE.............................................................................76
, Normale respiratoire veranderingen tijdens slaap......................................................76
Obstructief slaapapneu syndroom (OSAS)..................................................................77
3. Centrale Slaapapneu (CSA)....................................................................................78
4. Obesitas-Hypoventilatiesyndroom (OHS)...............................................................78
5. Overige slaapstoornissen met respiratoire impact.................................................79
6. Samenvattend overzicht........................................................................................79
H9: DE PULMONALE CIRCULATIE....................................................................80
LONGEMBOLIE (LE)............................................................................................................ 80
Epidemiologie............................................................................................................. 80
risicofactoren............................................................................................................. 80
Pathofysiologie........................................................................................................... 80
Kliniek........................................................................................................................ 81
Diagnose.................................................................................................................... 81
Behandeling............................................................................................................... 82
PULMONALE HYPERTENSIE (PH)............................................................................................. 83
Pathogenese.............................................................................................................. 83
Classificatie (Nice 2018).............................................................................................83
Epidemiologie............................................................................................................. 83
Kliniek........................................................................................................................ 83
Diagnose.................................................................................................................... 85
Pathologie.................................................................................................................. 85
Behandeling............................................................................................................... 85
overige stoornissen van pulmonale circulatie............................................................85
SAMENVATTING.................................................................................................................. 87
SEMEIOLOGISCHE DEMONSTRATIE PNEUMOLOGIE..........................................88
1. ALGEMEEN KADER..................................................................................................... 88
2. INSPECTIE.................................................................................................................. 88
3. PALPATIE.................................................................................................................... 88
4. PERCUSSIE................................................................................................................. 89
5. AUSCULTATIE............................................................................................................. 89
6. CASUISTIEK (SAMENGEVAT)........................................................................................... 90
7. SAMENVATTEND SCHEMA.......................................................................................... 91
, H1: DIAGNOSTISCHE METHODEN
1. BEELDVORMING VAN DE THORAX
Techniek Toepassing / indicatie Voordelen /
beperkingen
Standaard RX Eerste onderzoek bij alle long- en Goedkoop, snel; maar 2D
thorax (PA + thoraxpathologieën superpositie, beperkte
lateraal) specificiteit
CT thorax Detectie, lokalisatie en Hoofdmethode voor
karakterisatie van letsels (tumor, mediastinum, long, pleura;
infectie, ILD, embolie, metastasen) gebruik contraststof
HRCT (High Fijne detailbeelden van Detecteert letsels vóór RX
Resolution CT) longparenchym → ILD, fibrose, zichtbaar is
bronchiectasie
MRI Alternatief bij contrastallergie, Minder geschikt voor
Pancoast-tumor, cystische letsels, longparenchym
thoraxwandinvasie
Echografie Pleuraal vocht, geleiding punctie, Geen evaluatie van long zelf
diafragmabeweging
Angiografie Vasculaire afwijkingen (aneurysma, Invasief, zeldzaam;
embolie) vervangen door CT-
angiografie
2. BELANGRIJKSTE RADIOLOGISCHE PATRONEN (CT / RX)
Patroon Betekenis / oorzaak
Consolidatie Alveoli gevuld met exsudaat/cellen → pneumonie, bloeding, COP
Matglas Gedeeltelijke alveolaire vulling / verdikt interstitium → ontsteking,
oedeem, DAD
Reticulair Fijne lijnen = verdikt interstitium → fibrose, IPF, oedeem
Nodulair Meerdere ronde opaciteiten → metastasen, TBC, sarcoïdose
Cystisch Luchthoudende holtes → LCH, LAM, eindstadium fibrose
Honeycombing Clusters cysten = eindstadium fibrose
Crazy paving Matglas + verdikte septa → alveolaire proteïnose, DAD
Luchtbronchog Lucht gevulde bronchi in geconsolideerde long → pneumonie
ram
3. MEDIASTINUM EN DIAFRAGMA
Structuur Belangrijkste afwijkingen / oorzaken
Mediastin Verbreding door lymfomen, metastasen, thymoom, cysten of goiter.
um Pneumomediastinum = lucht in weke delen na trauma of ruptuur.
Diafragma Hoogstand: paralyse n. phrenicus, pleuravocht, atelectase.
Laagstand: emfyseem, spanningspneumothorax.
Beweging: fluoroscopie of echo; links beweegt sterker.
4. LONGPARENCHYM
Type afwijking Voorbeelden / Kernidee
LIEVEN DUPONT
Inhoudsopgave
H1: DIAGNOSTISCHE METHODEN.....................................................................4
1. BEELDVORMING VAN DE THORAX.........................................................................................4
2. BELANGRIJKSTE RADIOLOGISCHE PATRONEN (CT / RX)............................................................4
3. MEDIASTINUM EN DIAFRAGMA.............................................................................................4
4. LONGPARENCHYM............................................................................................................. 4
5. LONGFUNCTIE – BASISBEGRIPPEN.........................................................................................5
6. BRONCHIALE HYPERREACTIVITEIT......................................................................................... 5
7. GASUITWISSELING & BLOEDGAS.......................................................................................... 6
8. ENDOSCOPIE & INVASIEVE DIAGNOSTIEK...............................................................................6
9. PATHOLOGISCHE BASISPRINCIPES.........................................................................................6
KERNTEKST VOOR EXAMEN:............................................................................................ 7
H2: RESPIRATOIRE INFECTIES.........................................................................8
2.1. BOVENSTE LUCHTWEGINFECTIES.......................................................................................8
2.2 ACUTE BRONCHIOLITIS................................................................................................... 10
2.3 ACUTE TRACHEOBRONCHITIS..................................................................................10
2.4 ACUTE COPD-EXACERBATIE (AECOPD).....................................................................11
2.5 COMMUNITY-ACQUIRED PNEUMONIA (CAP).............................................................11
2.7 TUBERCULOSE (TB).................................................................................................. 14
2.8 NIET-TUBERCULEUZE MYCOBACTERIËN (NTM)....................................................................16
2.9 LONGINFECTIES BIJ IMMUUNGEDEPRIMEERDEN.......................................................19
🔑 EXAMENVUISTREGELS............................................................................................... 20
H3: OBSTRUCTIEVE LONGAANDOENINGEN......................................................21
ASTMA BRONCHIALE.......................................................................................................... 21
pathofysiologie........................................................................................................... 21
kliniek......................................................................................................................... 23
Diagnose.................................................................................................................... 23
behandeling............................................................................................................... 25
COPD............................................................................................................................... 28
kliniek......................................................................................................................... 30
behandeling............................................................................................................... 34
astma vs COPD........................................................................................................... 35
BRONCHIECTASIEËN............................................................................................................. 36
pathofysiologie........................................................................................................... 36
etiologie..................................................................................................................... 39
diagnose..................................................................................................................... 39
BEHANDELING............................................................................................................ 40
H4: NEOPLASIEËN VAN LONG EN THORAX......................................................42
, LONGCARCINOOM / BRONCHUSCARCINOOM..............................................................................42
Etiologie / Risicofactoren...........................................................................................42
Pathogenese.............................................................................................................. 42
Pathologie / Typen...................................................................................................... 44
Kliniek........................................................................................................................ 44
Diagnose.................................................................................................................... 45
classificatie en stadiëring...........................................................................................46
Behandeling............................................................................................................... 49
KLEINCELLIG LONGCARCINOOM (SCLC)......................................................................52
ZELDZAME LONGTUMOREN.................................................................................................... 53
CARCINOÏD TUMOR..................................................................................................... 53
ANDERE ZELDZAME LONGTUMOREN..........................................................................54
OVERZICHT: NEURO-ENDOCRIENE LONGTUMOREN....................................................54
SOLITAIRE PULMONALE NODULUS (SPN).................................................................................55
LONGMETASTASEN.............................................................................................................. 57
Terminologie.............................................................................................................. 57
Klinische presentatie..................................................................................................57
Diagnose.................................................................................................................... 57
Behandeling: metastasectomie..................................................................................58
Chirurgische techniek................................................................................................. 58
Resultaten & overleving............................................................................................. 58
MEDIASTINALE TUMOREN..................................................................................................... 59
Kliniek........................................................................................................................ 59
Diagnose.................................................................................................................... 59
Indeling naar lokalisatie............................................................................................. 59
Tumoren per compartiment.......................................................................................60
Beleid......................................................................................................................... 61
PLEURALE TUMOREN........................................................................................................... 63
algemeen................................................................................................................... 63
Maligne pleuraal mesothelioom..................................................................................63
Benigne pleurale tumoren..........................................................................................64
Pleurale metastasen................................................................................................... 65
H5: INTERSTITIËLE LONGPATHOLOGIE...........................................................66
ALGEMEEN........................................................................................................................ 66
overzicht van ILD........................................................................................................ 66
Pathogenese.............................................................................................................. 70
Diagnose.................................................................................................................... 70
Behandeling............................................................................................................... 72
H6: PLEURA, THORAXWAND EN DIAFRAGMAPATHOLOGIE...............................73
TABEL.............................................................................................................................. 73
PNEUMOTHORAX................................................................................................................. 73
Typen......................................................................................................................... 73
Symptomen................................................................................................................ 73
Diagnostiek................................................................................................................ 74
Behandeling............................................................................................................... 74
AANGEBOREN AFWIJKINGEN VAN DE THORAXWAND....................................................................74
Pectus excavatum...................................................................................................... 74
Pectus carinatum....................................................................................................... 75
AANDOENINGEN VAN HET DIAFRAGMA.....................................................................................75
H8: SLAAP EN RESPIRATIE.............................................................................76
, Normale respiratoire veranderingen tijdens slaap......................................................76
Obstructief slaapapneu syndroom (OSAS)..................................................................77
3. Centrale Slaapapneu (CSA)....................................................................................78
4. Obesitas-Hypoventilatiesyndroom (OHS)...............................................................78
5. Overige slaapstoornissen met respiratoire impact.................................................79
6. Samenvattend overzicht........................................................................................79
H9: DE PULMONALE CIRCULATIE....................................................................80
LONGEMBOLIE (LE)............................................................................................................ 80
Epidemiologie............................................................................................................. 80
risicofactoren............................................................................................................. 80
Pathofysiologie........................................................................................................... 80
Kliniek........................................................................................................................ 81
Diagnose.................................................................................................................... 81
Behandeling............................................................................................................... 82
PULMONALE HYPERTENSIE (PH)............................................................................................. 83
Pathogenese.............................................................................................................. 83
Classificatie (Nice 2018).............................................................................................83
Epidemiologie............................................................................................................. 83
Kliniek........................................................................................................................ 83
Diagnose.................................................................................................................... 85
Pathologie.................................................................................................................. 85
Behandeling............................................................................................................... 85
overige stoornissen van pulmonale circulatie............................................................85
SAMENVATTING.................................................................................................................. 87
SEMEIOLOGISCHE DEMONSTRATIE PNEUMOLOGIE..........................................88
1. ALGEMEEN KADER..................................................................................................... 88
2. INSPECTIE.................................................................................................................. 88
3. PALPATIE.................................................................................................................... 88
4. PERCUSSIE................................................................................................................. 89
5. AUSCULTATIE............................................................................................................. 89
6. CASUISTIEK (SAMENGEVAT)........................................................................................... 90
7. SAMENVATTEND SCHEMA.......................................................................................... 91
, H1: DIAGNOSTISCHE METHODEN
1. BEELDVORMING VAN DE THORAX
Techniek Toepassing / indicatie Voordelen /
beperkingen
Standaard RX Eerste onderzoek bij alle long- en Goedkoop, snel; maar 2D
thorax (PA + thoraxpathologieën superpositie, beperkte
lateraal) specificiteit
CT thorax Detectie, lokalisatie en Hoofdmethode voor
karakterisatie van letsels (tumor, mediastinum, long, pleura;
infectie, ILD, embolie, metastasen) gebruik contraststof
HRCT (High Fijne detailbeelden van Detecteert letsels vóór RX
Resolution CT) longparenchym → ILD, fibrose, zichtbaar is
bronchiectasie
MRI Alternatief bij contrastallergie, Minder geschikt voor
Pancoast-tumor, cystische letsels, longparenchym
thoraxwandinvasie
Echografie Pleuraal vocht, geleiding punctie, Geen evaluatie van long zelf
diafragmabeweging
Angiografie Vasculaire afwijkingen (aneurysma, Invasief, zeldzaam;
embolie) vervangen door CT-
angiografie
2. BELANGRIJKSTE RADIOLOGISCHE PATRONEN (CT / RX)
Patroon Betekenis / oorzaak
Consolidatie Alveoli gevuld met exsudaat/cellen → pneumonie, bloeding, COP
Matglas Gedeeltelijke alveolaire vulling / verdikt interstitium → ontsteking,
oedeem, DAD
Reticulair Fijne lijnen = verdikt interstitium → fibrose, IPF, oedeem
Nodulair Meerdere ronde opaciteiten → metastasen, TBC, sarcoïdose
Cystisch Luchthoudende holtes → LCH, LAM, eindstadium fibrose
Honeycombing Clusters cysten = eindstadium fibrose
Crazy paving Matglas + verdikte septa → alveolaire proteïnose, DAD
Luchtbronchog Lucht gevulde bronchi in geconsolideerde long → pneumonie
ram
3. MEDIASTINUM EN DIAFRAGMA
Structuur Belangrijkste afwijkingen / oorzaken
Mediastin Verbreding door lymfomen, metastasen, thymoom, cysten of goiter.
um Pneumomediastinum = lucht in weke delen na trauma of ruptuur.
Diafragma Hoogstand: paralyse n. phrenicus, pleuravocht, atelectase.
Laagstand: emfyseem, spanningspneumothorax.
Beweging: fluoroscopie of echo; links beweegt sterker.
4. LONGPARENCHYM
Type afwijking Voorbeelden / Kernidee
