Sert metal akciğer hastalığı

Özet

Sert metal akciğer hastalığı, tungsten karbür ve kobalt içeren tozların solunmasıyla ilişkili mesleki bir akciğer hastalığıdır; kaynak taşlama ve sert metal üretimi gibi işlerde maruziyet sorgulanmalıdır. İnce kesit BT'de sentrilobüler nodüller ve buzlu cam erken/aktif paterni, retikülasyon ve traksiyon bronşektazisi ise fibrotik hasarı gösterebilir; ekspirasyon mozaik hava hapsini ortaya çıkarır. Görüntüleme tek başına mesleki etkeni kanıtlamaz ve histopatoloji bazen dev hücreli interstisyel pnömoni paternini gösterir. Maruziyet öyküsünün alınmaması bulguların idiyopatik interstisyel hastalık olarak yanlış sınıflandırılmasına neden olabilir.

Faz ve pencere

HRCT tanısal

Kontrastsız ince kesit inspirasyon görüntülerinde sentrilobüler nodüller, yamalı buzlu cam, düzensiz retikülasyon, konsolidasyon, bül ve subplevral çizgisel opaklıklar araştırılır; ekspirasyon serisi küçük havayolu hastalığına bağlı lobüler hava hapsini belirginleştirir.

Önerilen pencereler: Akciğer (G 1500 / M -600), Mediasten (G 350 / M 50).

BT bulguları

• Lobül merkezinde, plevraya kadar uzanmayan, silik sentrilobüler mikronodüller
• Nodüllerin çevresinde yamalı buzlu cam yoğunluğu; bronşiolosentrik dağılım
• Bazı alanlarda düzensiz retiküler çizgiler ve alveoler konsolidasyon
• Ekspirasyonda belirginleşen lobüler mozaik atenüasyon ve hava hapsi
• Kronik hasarda traksiyon bronşektazisi, parankimal çekinti veya bal peteği görünümü
• Bazı olgularda bül veya santral amfizem eşlik edebilir; kronik hasarda retikülasyon ve traksiyon bronşektazisi gelişebilir.
• Plevral çizgiye değmeyen sentrilobüler nodüller; perilenfatik dağılım varsa alternatif mesleki/granülomatöz nedenleri düşün

Normalde

Ekspirasyon serisinde hava hapsi değerlendirmek amacıyla kontrastsız ince kesit inspirasyon ve ekspirasyon görüntüleri karşılaştırılır. Multiplanar reformasyonlar hastalığın kraniokaudal dağılımını belirlemede kullanılır; bu sayede nodüllerin ve fibrotik değişikliklerin loblardaki konumu karşılaştırılabilir.

Ayırıcı tanı

Fibrotik hipersensitivite pnömonisi

sentrilobüler buzlu cam nodülleri ve hava hapsi yapabilir; üç yoğunluk paterni, üst zon/peribronkovasküler fibrozis ve antijen maruziyeti destekler.

Sarkoidoz

granülomatöz hastalıklar arasında ayırıcı tanıda yer alır; CT bulguları tipik ve atipik olarak tanımlanmış olup, diğer hastalıklarla karışabilir.

Sigara ile ilişkili bronzsiyolit ve sigara bağımlılığına bağlı interstisyel fibrozis

sigara öyküsü olanlarda buzlu cam opaklıkları, sentrilobüler nodüller ve amfizem bulguları gösterir.

Enfeksiyöz bronşiolit

dallanan sentrilobüler nodüller ve tomurcuklanan ağaç paterni oluşturur; bronşiol içi sekresyon, akut semptom ve enfeksiyon odağı destekler.

Asbestoz

USIP paterni gibi bazal ve subplevral retikülasyon, traksiyon bronşektazisi ve bal peteği yapar; diğer interstisyel hastalıklardan farklıdır.

Tuzaklar

• BT paterni özgül değildir; tungsten/kobalt maruziyetini öğrenmeden yalnız görüntüye bakarak sert metal hastalığı tanısı koyma.
• Ekspirasyon görüntülemesi küçük havayolu hastalığına bağlı hava hapsini değerlendirmek amacıyla rutin olarak yapılmalıdır.
• Sert metal hastalığındaki nodüler dağılım bazen sarkoidozu taklit edebilir; ayırıcı tanıda klinik ve element analizi verileri göz önüne alınmalıdır.
• İleri fibrozis bal peteği ve traksiyon bronşektazisi oluşturabilir; gelişmiş hastalıkta sentrilobüler mikronodüller baskın olmayabilir, bu nedenle mesleki etkeni gözden kaçırma.

Kendini dene

1. Sert metal tozuna mesleki maruziyeti olan kişide silik sentrilobüler nodüller ve yamalı buzlu cam görülüyor. En olası neden hangisidir?

   • Sert metal akciğer hastalığı
   • Sarkoidoz
   • İdiyopatik pulmoner fibrozis
   • Pulmoner alveoler proteinozis
   Cevabı göster

   Sert metal akciğer hastalığı. Tungsten karbür veya kobalt içeren toz maruziyetiyle birlikte bronşiolosentrik nodül ve buzlu cam paterni sert metal hastalığını destekler. Sarkoidoz perilenfatik nodüller, idiyopatik fibrozis subplevral bazal bal peteği, alveoler proteinozis coğrafi kaldırım taşı görünümü yapar.

2. BT'de sert metal akciğer hastalığı daraltıcı bronşiolit nedeniyle ekspirasyon görüntülerinde mozaik atenüasyon ve hava hapsi oluşturur. Bu bulgunun en olası nedeni nedir?

   • Hava hapsi
   • Kalsifiye granülom
   • Alveoler kanama
   • Plevral plak
   Cevabı göster

   Hava hapsi. Ekspirasyonda yoğunlaşmayan lobül küçük hava yolu obstrüksiyonuna bağlı hava hapsidir. Sert metal akciğer hastalığında daraltıcı bronşiolit nedeniyle ekspirasyon görüntülerinde lobüler mozaik atenüasyon ve hava hapsi gözlenir.

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 13 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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