Det finns knappast n\u00e5got begrepp inom radiologin som \u00e4r s\u00e5 frekvent anv\u00e4nt och omdiskuterat som \u201dinfiltrat\u201d i lungorna [1-4], inte minst i samband med lungr\u00f6ntgen, men \u00e4ven ofta vid datortomografi. Det \u00e4r ofta den prim\u00e4ra fr\u00e5gest\u00e4llning, inte s\u00e4llan d\u00e5 man fr\u00e5n anamnesen kan ana att remittenten misst\u00e4nker eller vill utesluta pneumoni. Det anv\u00e4nds ocks\u00e5 frekvent i r\u00f6ntgensvar och inte s\u00e4llan som enda negering av lungpatologi (\u201dinga lunginfiltrat\u201d) vid en normal lungr\u00f6ntgen. Infiltrat anv\u00e4nds ocks\u00e5 f\u00f6r att beskriva olika typer av f\u00f6rt\u00e4tningar (attenuerings\u00f6kning) i lungorna utan att n\u00e4rmare analysera vad det kan representera, kanske underf\u00f6rst\u00e5tt liktydigt med pneumoni. <\/p>\n\n\n\n
Definition infiltrat<\/em> <\/p>\n\n\n\n Enligt Fleischner Society\u2019s nomenklaturkommitt\u00e9 definieras \u201cinfiltrat\u201d som \u201cany substance or type of cell that occurs within or spreads through the interstices (interstitium and\/or alveoli) of the lung, that is foreign to the lung, or that accumulates in greater than normal quantity within it\u201d och \u201ddistinguishes processes that do not distort lung architecture from expanding processes that do\u201d [5]. I radiologisk mening \u00e4r ett infiltrat vilken oskarpt avgr\u00e4nsbar lungf\u00f6rt\u00e4tning som helst (\u201cany poorly defined opacity in the lung\u201d) [5]. Patofysiologiskt kan det allts\u00e5 r\u00f6ra sig om exsudat, blod, \u00f6dem, visa cancerformer (mucin\u00f6st adenocarcinom), protein\u00f6st material, etc. [3]. Fleischner Socitey har sedan 1984 avr\u00e5tt fr\u00e5n att anv\u00e4nda termen infiltrat [5, 6], d\u00e5 det ocks\u00e5 visat sig att termen betyder olika f\u00f6r olika doktorer [7]. <\/p>\n\n\n\n F\u00f6rt\u00e4tning i st\u00e4llet f\u00f6r infiltrat<\/em> <\/p>\n\n\n\n Infiltrat \u00e4r s\u00e5ledes en synnerligen ospecifik term som kan representera en rad olika sjukdomstillst\u00e5nd. Om det \u00e4r s\u00e5 att b\u00e5de remittenter och radiologer i Sverige prim\u00e4rt uppfattar termen som liktydig med n\u00e5gon form av pneumoni b\u00f6r vi genast sluta att anv\u00e4nda begreppet. Fleischner Society f\u00f6redrar begreppet \u201dopacity\u201d, allts\u00e5 f\u00f6rt\u00e4tning. Det \u00e4r viktigt att f\u00e5 remittenten att f\u00f6rst\u00e5 att r\u00f6ntgenfyndet \u00e4r ospecifikt och f\u00f6r att n\u00e5 en sannolik diagnos m\u00e5ste det kopplas ihop med kliniska tecken, symtom och andra unders\u00f6kningar f\u00f6r att n\u00e5 en sannolik diagnos. Det kan vara v\u00e4rt att p\u00e5minna om att ischemiska lungskador sekund\u00e4rt till lungembolier \u00e4r en viktig differentialdiagnos [8]. <\/p>\n\n\n\n Normala lungor vid en r\u00f6ntgenunders\u00f6kning kan ist\u00e4llet f\u00f6r \u201dInga lungfiltrat\u201d beskrivas som \u201dInga lungf\u00f6r\u00e4ndringar\u201d eller \u201dIntet patologiskt i lungorna\u201d s\u00e5 negerar man ju all typ av patologi. <\/p>\n\n\n\n\n\n 1<\/sup>Ulf Nyman, docent och 2<\/sup>Kerstin Cederlund, docent <\/em><\/p>\n\n\n\n B\u00e5da medlemmar i Svensk f\u00f6rening f\u00f6r thoraxradiologi <\/em><\/p>\n\n\n\n Artikeln godk\u00e4nd av styrelsen i Svensk f\u00f6rening f\u00f6r thoraxradiologi <\/em><\/p>\n\n\n\n 1<\/sup>Institutionen f\u00f6r translationell medicin, Divisionen f\u00f6r medicinsk radiologi, Lunds Universitet, Malm\u00f6 <\/em><\/p>\n\n\n\n 2<\/sup>VO R\u00f6ntgen, S\u00f6dert\u00e4lje Sjukhus, S\u00f6dert\u00e4lje <\/em><\/p>\n\n\n\n 2<\/sup>Institutionen f\u00f6r klinisk vetenskap, intervention och teknik vid Karolinska institutet, Divisionen f\u00f6r medicinsk service och teknik, Stockholm <\/em><\/p>\n\n\n\n\n\n Referenser<\/strong> <\/p>\n\n\n\n 1. Friedman PJ. Radiologic reporting: the description of alveolar filling. AJR Am J Roentgenol. 1983;141:617-8. <\/p>\n\n\n\n 2. Tuddenham WJ. A word for tacticians, spies and nonpulmonary radiologists. Radiographics. 1984;4:671. <\/p>\n\n\n\n 3. Austin J, Simon M, Trapnell D, et al. The Fleischner Society glossary: critique and revisions. AJR Am J Roentgenol. 1985;145:1096-8. <\/p>\n\n\n\n 4. Hall FM. Fleischner Society glossary of terms: infiltrates. Radiology. 2008;248:1083. <\/p>\n\n\n\n 5. Tuddenham WJ. Glossary of terms for thoracic radiology: recommendations of the Nomenclature Committee of the Fleischner Society. AJR Am J Roentgenol. 1984;143:509-17. <\/p>\n\n\n\n 6. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246:697-722. <\/p>\n\n\n\n 7. Patterson HS,Sponaugle DN. Is infiltrate a useful term in the interpretation of chest radiographs? Physician survey results. Radiology. 2005;235:5-8. <\/p>\n\n\n\n 8. Nyman U. Infiltrat som tecken p\u00e5 lungembolism – den g\u00e4ckande skuggan. L\u00e4kartidningen. 2009;106:1262-7. <\/p>\n","protected":false},"excerpt":{"rendered":" Det finns knappast n\u00e5got begrepp inom radiologin som \u00e4r s\u00e5 frekvent anv\u00e4nt och omdiskuterat som \u201dinfiltrat\u201d i lungorna [1-4], inte minst i samband med lungr\u00f6ntgen, men \u00e4ven ofta vid datortomografi. Det \u00e4r ofta den prim\u00e4ra fr\u00e5gest\u00e4llning, inte s\u00e4llan d\u00e5 man fr\u00e5n anamnesen kan ana att remittenten misst\u00e4nker eller vill utesluta pneumoni. Det anv\u00e4nds ocks\u00e5 frekvent … L\u00e4s hela<\/a><\/p>\n","protected":false},"author":2,"featured_media":81,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4],"class_list":["post-80","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-thoraxradiologi"],"acf":[],"_links":{"self":[{"href":"https:\/\/slf.se\/sfmr\/imago-medica\/wp-json\/wp\/v2\/posts\/80","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/slf.se\/sfmr\/imago-medica\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/slf.se\/sfmr\/imago-medica\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/slf.se\/sfmr\/imago-medica\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/slf.se\/sfmr\/imago-medica\/wp-json\/wp\/v2\/comments?post=80"}],"version-history":[{"count":3,"href":"https:\/\/slf.se\/sfmr\/imago-medica\/wp-json\/wp\/v2\/posts\/80\/revisions"}],"predecessor-version":[{"id":95,"href":"https:\/\/slf.se\/sfmr\/imago-medica\/wp-json\/wp\/v2\/posts\/80\/revisions\/95"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/slf.se\/sfmr\/imago-medica\/wp-json\/wp\/v2\/media\/81"}],"wp:attachment":[{"href":"https:\/\/slf.se\/sfmr\/imago-medica\/wp-json\/wp\/v2\/media?parent=80"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/slf.se\/sfmr\/imago-medica\/wp-json\/wp\/v2\/categories?post=80"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}