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Figure 1. Diffuse bilateral air-space opacities consistent with pneumonia. Possible causative organisms include Pneumocystis carinii. (Illustration courtesy of the Department of Radiology, New York Presbyterian Hospital.)
Figure 2. Persistent bilateral diffuse parenchymal opacities and probable cystic spaces. A right-sided pneumothorax is approximately 50% in size. (Illustration courtesy of the Department of Radiology, New York Presbyterian Hospital.)
Figure 3. Persistent bilateral diffuse opacities with insertion of right thoracic vent in the mid-hemithorax and reexpansion of the right lung. A left-sided pneumothorax is noted. (Illustration courtesy of the Department of Radiology, New York Presbyterian Hospital.)
Figure 4. Insertion of a thoracovent catheter in the left mid-hemithorax. A right thoracovent catheter is unchanged. There has been reexpansion of the right and left lungs. No discernible pneumothorax is noted on either side. A large cystic space at the left base and 2 smaller cystic spaces medially in the right lower lung field are noted amid the bilateral diffuse parenchymal opacities. (Illustration courtesy of the Department of Radiology, New York Presbyterian Hospital.)
Gambaran Radiologis pada foto thorax pada penyakit pneumonia antara lain:
Perselubungan homogen atau inhomogen sesuai dengan lobus atau segment paru secara anantomis. Batasnya tegas, walaupun pada mulanya kurang jelas. Volume paru tidak berubah, tidak seperti atelektasis dimana paru mengecil. Tidak tampak deviasi trachea/septum/fissure/ seperti pada atelektasis.
This 67 year-old lady was admitted last night with a 2 day history of shortness of breath, and cough productive of green sputum. Examination of the chest: Coarse crepitations at the left base. Diagnosis Lower Left Lobe Pneumonia CXR
Consolidation of the left lower lobe & Loss of left hemi-diaphragm silhouette Radiological Diagnosis = Left Lower Lobe pneumonia The silhouette sign The silhouette sign is an important radiological principle. The loss of a silhouette on chest x-ray suggests pathology in the adjacent lung.
Figure 3-42 Pulmonary hemorrhage. The fluffy alveolar pattern is produced by fluid filling the alveoli.
TB paru
Gambar: adanya kalsifikasi parahiler kanan (Ghon kompleks) disertai pembesaran kelenjar hillus kanan. (Courtesy: Andrea T Cruz). Sedangkan salah satu bentuk TB paru berat adalah TB milier.
Figure 10 : Infectious bronchiolitis and bronchopneumonia: radiographic findings. Posteroanterior chest radiograph shows poorly defined nodular opacities and foci of consolidation in the right lower lobe. The patient was a 48-year-old man with Mycoplasma bronchiolitis and bronchopneumonia. (Courtesy of Dr. Atsushi Nambu, Department of Radiology, University of Yamanashi, Yamanashi, Japan.)
Figure 1 : Bronchopneumonia. Posteroanterior chest radiograph shows patchy consolidation in the left upper and lower lobes. Note inhomogeneous increased opacity of the left heart compared to the region of the right atrium consistent with consolidation in the retrocardiac region of the left lower lobe. The patient was a 36-year-old woman with bronchopneumonia.
Patient: 5 year old male History: Cough and wheeze. Fever. Widespread crackles and wheeze.
Findings: 1. Bordeline overinflation 2. Perihilar peribronchial thickening 3. No focal collapse or consolidation Diagnosis: Perihilar peribronchial thickening is often a subjective diagnosis based on 'too many lines' at hila. look for the one or two end on bronchi at each hilum. Normally they are pencil thin; if smudged or thick walled there is perihilar peribronchial thickening. This reflects inflammatory swelling of the bronchi.
Bronchopneumonia, bilateral
CASE Thickened bronchial walls and confluencing peribronchovascular infiltrates in both lower lung fields.
-Cor tidak membesar -Sinuses dan diafragma normal -Pulmo: Hilus kanan tertutup bayangan jantung, hilus kiri kabur Corak bronkovaskuler normal Tampak perselubungan opak inhomogen berbatas tegas di lapang atas paru kanan dengan air
Simetris Inspirasi cukup Cor membesar ke lateral kiri, apex membulat, pinggang jantung mendatar Sinus ka & ki normal, diafragma normal Pulmo: - hilus kiri tertutup bayangan jantung -Hilus kanan kabur -Corakan paru bertambah -tampak bayangan opak bulat inhomogen di lapang atas paru kanan Kesan: kardiomegali tanpa bendungan paru disertai pneumonia Dr. Harry -Cor normal [ANAK], CTR=60% - Febris -> DD/ Tb, pneumonia, BP - Perselubungan inhomogen opak berbatas tegas di lapang atas paru kanan disertai air bronchogram [PNEUMONIA] - Terdapat perbercakan di lapang bawah paru kanan [BRONCHOPNEUMONIA] -Kesan: penumonia N BP
DR. HARRY: Cor normal -Diaphragm elevasi Pulmo: -Sinus normal tajam -Hilus kanan normal, kiri tertutup perselubungan -Bronchovaskuler kanan normal, kiri tertutup perselubungan -Perselubungan opaque homogen diffuse di seluruh lapang paru kiri -Trakea deviasi ke kiri -Paru kanan hyperlusen -Volume paru kanan bertambah -Bronchovuskuler berkurang -KESAN : ATELEKTASIS DENGAN EMFISEMA KOMPENSATORI
Simetris Inspirasi cukup Batas jantung kanan tertutup bayangan opak Sinus dan diafragma kanan tertutup bayangan opak Sinus dan diafragma kiri normal Pulmo: -Hilus kiri tertutup bayangan jantung -hilus kanan tertutup bayangan opak -corakan paru kiri bertambah -corakan paru kanan tidak dapat dinilai -tampak perselubungan opak homogen difus di seluruh hemithorax kanan, pleura line (+), dan tampak bayangan opak berbatas tegas di lapang paru bawah tengah setinggi vertebra T9 Kesan: efusi pleura kanan dan corpus alienum di lapang paru bawah kanan
asimetris, cor tidak membesar Sinuses dan diafragma normal Pulmo: -Hili tertutup bayangan opak -- corak bronkovaskular bertamabah. Tidak tampak bercak lunak -Kesan: transient reespiratory distres of newborn DR. HARRY GALUH -Tampak bayangan garis2 opak retikuler radier perifer ke hilus KESAN : TTRN [TRANSIENT TACHYPNEA RESPIRATORY DISTRESS OF NEWBORN]
Inspirasi cukup, simetris, cor tiak membesar, sinuses an diafragma normal Pulmo: -Hilus kanan kabur, kiri normal -corakan paru bertambah, -Tampak bayangan opak homogen berbentuk oval/lemon berbatas tegas di lapang paru kanan [fisura minor kanan] -Foto lateral: sinus anterior normal, sinus posterior tumpul [EFUSI] -Retrosternal space normal [less than 1/3 sternum, more than 1/3= RV hypertrofi] -Terdapat perselubungan opak yang mengisi ruang retrocardial space bawah [LV hypertrofi] -Ada bayangan opak homogen di sekitar hilus, di fisura minor -Kesan: efusi pleura terlokalisir (vanishing tumor) dan efusi pleura
Meningkatnya bayangan radiolusen dan avaskuler di daerah yang terkena. Pendorongan mediastinum ke arah kontralateral . Meningkatnya ketajaman batas mediastinum (menyerupai pneumo-mediastinum), sudut kostofrenik tumpul atau adanya double daerah diafragma. Bagian pneumotoraks akan tampak hitam, rata dan paru yang kolaps akan tampak garis yang merupakan tepi paru. Kadang-kadang paru yang kolaps tidak membentuk garis, akan tetapi terbentuk lobuler yang sesuai dengan lobus paru. Sebaliknya, paru yang mengalami kolaps tersebut, hanya tampak seperti massa yang berada di daerah hilus. Keadan ini menunjukkan kolaps paru yang luas sekali. Besar kolaps paru tidak selalu berkaitan dengan berat ringan sesak nafas yang dikeluhkan.
Gambar 1. Radiografi lateral pada pasien perempuan berusia 3 tahun dengan riwayat persalinan prematur, penyakit paru kronis, dan asma yang menderita pneumonitis viral dan batuk persisten.