RADIOLOŠKA SLIKA COVID-19 PNEUMONIJE

Aleksandra Đurić-Stefanović

doi:10.5937/smclk2-32749

Aleksandra Đurić-Stefanović Prof. dr sc. med.

DOI: https://doi.org/10.5937/smclk2-32749

Ključne reči: KOVID-19 pneumonija, kompjuterizovana tomografija, radiografija pluća

Sažetak

Intrersticijumska pneumonija je dominantna manifestacija oboljenja COVID-19. Cilj rada je da se prikaže spektar tipičnih radioloških (CT i radiografskih) nalaza COVID-19 pneumonije, tehnika CT pregleda, tipovi i evolucija inflamatornih promena u plućima, kriterijumi za procenu verovatnoće COVID-19 pneumonije u odnosu na druge intersticijumske pneumonije, principi bodovanja (scoring) za definiciju obima COVID-19 pneumonije na osnovu CT nalaza i radiografije. Standardni protokol CT pregleda je nativni CT pregled grudnog koša, a zbog visoke senzitivnosti niskodoznih CT protokola za detekciju promena u plućima, ova tehnika snimanja je postala široko zastupljena u radiološkoj praksi tokom pandemije COVID-19. Obostrane, multiple, kružne ili slivene zone denziteta “mlečnog stakla”, dominantno lokalizovane subpleuralno, periferno i posteriorno, obično najobimnije u donjim režnjevima, predstavljaju tipičnu CT prezentaciju COVID-19 pneumonije. U kasnijem stadijumu se mogu razviti i konsolidacije. Na rendgenskom snimku pluća može da se vidi homogeno smanjena transparencija u lateralnim plućnim poljima, kružna i nepravilna oblačasta zasenčenja i konfluentna mrljasta zasenčenja, obično najobimnija bazalno i lateralno. Za procenu verovatnoće COVID-19 pneumonije na osnovu kriterijuma tipičnog/atipičnog CT nalaza koriste se RSNA i CO-RADS kriterijumi. Prema CT karakteristikama promena u plućima i vremenskoj dinamici njihove prezentacije, definisana su četiri stadijuma COVID-19 pneumonije: rani, progresivni, stadijum konsolidacije i organizacije. Za procenu obima i težine pneumonije CT-om, predloženi su različiti sistemi bodovanja od kojih je najšire prihvaćen CT severity scoring sistem koji se zasniva na vizuelnoj, semikvantitativnoj proceni procentualne zahvaćenosti parenhima svakog od pet lobusa pluća zapaljenskim promenama na skali od 1 (<5%) do 5 (>75%), tako da maksimalni skor može da iznosi 25.

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