THORAX

PATHOLOGY
By : Ilham Dwiretya & Karina Azariatri
Preceptor : Dr. Harry Galuh, dr. Sp.Rad(K)
KELAINAN PADA FOTO POLOS
KONVENSIONAL
Kelainan Pada
Foto Polos
Konvensional

RADIOOPAK RADIOLUSEN

DIFUSE NODULER LINIER

HOMOGEN

PARU

PLEURA

INHOMOGEN
DESKRIPSI KELAINAN RADIOOPAQUE
Perbercakan (patchy) Massa
 Bercak atau noda keras  Ukuran >3 cm
 Infiltrat/bercak lunak
Perselubungan/Konsolidasi
Nodul  Fluffy (berbulu halus)
 Besar: 2-3 cm  Cloudlike (seperti awan/kabut)
 Kecil: 0,5-2 cm  Hazy (kabur)
 Halus/milier: <0,5 cm
PNEUMONIA
Konsolidasi paru yang dihasilkan
oleh eksudat inflamasi yang
biasanya terjadi karena
infectious agents.
Karena banyaknya
mikroorganisme yang
menghasilkan temuan-temuan
yang hampir serupa, maka sulit
untuk mengidentifikasi organisme
sebagai etiologi dalam
presentasi radiografis itu sendiri.
Pattern of Disease Likely Causative Organism
Upper lobe cavitary pneumonia with spread to
the opposite lower lobe
Mycobacterium tuberculosis (TB)
Upper lobe lobar pneumonia with bulging
interlobar fissure
Klebsiella pneumoniae
Pseudomonas aeruginosa or anaerobic
Lower lobe cavitary pneumonia
organisms (Bacteroides)
Perihilar interstitial disease or perihilar
Pneumocystis carinii (jiroveci)
airspace disease
Thin-walled upper lobe cavity Coccidioides (coccidiomycosis), TB
Airspace disease with effusion Streptococci, staphylococci, TB
Diffuse nodules
Histoplasma, Coccidioides, Mycobacterium
tuberculosis (histoplasmosis, coccidiomycosis, TB)
Soft-tissue, finger-like shadows in upper lobes
Aspergillus (allergic bronchopulmonary
aspergillosis)
Solitary pulmonary nodule Cryptococcus (cryptococcosis)
Spherical soft-tissue mass in a thin-walled
Aspergillus (aspergilloma)
upper lobe cavity
BERDASARKAN GAMBARAN RADIOLOGIS
The prototypical lobar pneumonia is pneumococcal Pattern Characteristics
pneumonia caused by Streptococcus pneumoniae
Homogeneous consolidation of
Lobar affected lobe with air
The prototypical bronchopneumonia is caused by bronchogram
Staphylococcus aureus. Patchy airspace disease frequently
involving several segments
The prototypes for interstitial pneumonia are viral Segmental (bronchopneumonia) simultaneously; no air
bronchogram; atelectasis may be
pneumonia, Mycoplasma pneumoniae, and Pneumocystis
associated
pneumonia in patients with acquired immunodeficiency
Reticular interstitial disease usually
syn- drome (AIDS). diffusely spread throughout the
Interstitial lungs early in the disease process;
These round pneumonias are almost always posterior frequently progresses to airspace
in the lungs, usually in the lower lobes. Causative disease
agents include Haemophilus influenzae, Streptococcus, Spherically shaped pneumonia
and Pneumococcus. Round usually seen in the lower lobes of
children; may resemble a mass
The prototypical organism producing cavitary Produced by numerous
pneumonia is Mycobacterium tuberculosis. microorganisms, chief amongst
Cavitary
them being Mycobacterium
tuberculosis
Lobar pneumonia (Right upper lobe Segmental pneumonia (Staphylococcal
pneumococcal pneumonia) bronchopneumonia)
Interstitial pneumonia (Pneumocystis Round pneumonia
carinii (jiroved) pneumonia)
ABSES PARU
Abses paru kiri

Peradangan di jaringan paru yang

menimbulkan nekrosis dengan
pengumpulan nanah
Lokalisasi abses paru umumnya 75%
berada di lobus inferior paru kanan
Bayangan bulat dinding tebal
Air fluid level
Tidak ada jaringan granulasi di
dalamnya
Jaringan infiltrat di sekitarnya
Paling sering di lapangan bawah paru
TUBERKULOSIS PARU
Primary Pulmonary
Tuberculosis
There is prominence of the right
hilum (black arrow) caused by hilar
adenopathy. Unilateral hilar
adenopathy may be the only
manifestation of primary infection
with Mycobacterium tuberculosis,
especially in children. When it
produces pneumonia, primary TB
affects the upper lobes (solid white
arrows) slightly more than the
lower lobes (dotted white arrows).
Post-Primary Tuberculosis
(“Reactive TB”)
Most cases of TB in adults occur as reactivation of a primary focus of
infection acquired in childhood. The infection is limited mainly to the
apical and posterior segments of the upper lobes and the superior
segments of the lower lobes. Caseous necrosis and the tubercle
(accumulations of mononuclear macrophages, Langhans giant cells
surrounded by lymphocytes and fibroblasts) are the pathologic
hallmarks of postprimary TB.

Healing typically occurs with fibrosis and contraction.

There is a cavitary pneumonia in both upper lobes (solid white

arrows). Numerous lucencies (cavities) are seen in the airspace
disease in both upper lobes (solid black arrow on the left). A cavitary
upper lobe pneumonia is presumptively TB, until proven otherwise. In
addition, there is airspace disease in the lingula (dotted white arrow),
another nding suggestive of TB, a disease which can spread via a
transbronchial route to the opposite lower lobe or another lobe in
either lung.
Miliary Tuberculosis
The onset is insidious. Fever, chills, and night sweats are
common. It may take weeks between the time of
dissemination and the radiographic appearance of
disease. Miliary TB may occur as a manifestation of
either primary TB or postprimary TB, although the
clinical appearance of miliary TB may not occur for
many years after initial infection.

When first visible, the military nodules measure about

1mm in size; they can grow to 2 to 3 mm if left
untreated. When treated, clearing is rapid. Miliary TB
seldom, if ever, heals with calcifications.
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
Emphysema

Chronic obstructive lung disease

(COPD) is defined as a disease of air
flow obstruction due to chronic
bronchitis or emphysema.

Chronic bronchitis is defined clinically

by productive cough, whereas
emphysema is defined pathologically
by the presence of permanent and
abnormal enlargement and
destruction of the air spaces distal to
the terminal bronchioles.
 Bronkhitis Kronis
Tidak selalu memberikan
gambaran khas pada foto toraks
Berdasarkan pemeriksaan klinis
dan laboratorium  diagnosis
dapat ditegakkan
Gambaran Radiologi :
 Corakan retikuler paru bertambah,
terutama basal
 Cuffing Sign
 Trem Line
 TUMOR PARU
 tumor paru primer  solitary
nodule
 Bayangan opak, padat, berbentuk
oval, batasnya tegas bisa regular
atau irregular
 Tumor paru dapat bermanifestasi
membentuk massa pada paru,
obstruksi bronkial, atau penyebaran
(direct extension or metatatic lesion).
METASTASIS INTRAPULMONAL

Manifestasi :
Nodule multiple
 Terbentuk bayangan
oval/bulat opak multiple,
ukuran berbeda-beda (dari
micronodular, coin lesion, s.d
“cannonball masses”) dengan
batas tegas.
AIR CONTAING LESION IN THE LUNG
( BLEBS & BULLAE, CYST & CAVITIES)
Bleb : udara yg terletak pd visceral pleura. Biasanya terletak di
apex. Dindingnya sangat tipis, lebih terlihat pada pemeriksaan CT
Bullae : bleb > 1 cm. dindingnya tipis < 1mm. biasanya berhubungan
dengan emphysema, terletak pada parenkim paru
Kista : udara pada parenkim paru atau mediastinum. Dindingnya
lebih tebal <3mm
Kavitas : seperti kista tapi dindingnya >3mm s.d beberapa cm
KISTA PARU

Gambaran radiologi :
1. Bayangan bulat lusen
2. Dinding tipis
3. Air fluid level bila disertai
infeksi sekunder
 PNEUMOTHORAX

 Pneumothoax adalah kondisi saat udara

memasuki rongga pleura.
Patpat : masuknya udara  meningkatkan
tekanan negative sampai lebih tinggi dari
tekanan intraalveolar  paru-paru kolaps
Gambaran radiologi :
1. Garis putih Pleural line
2. Bayangan lusen distal pleura visceral
3. Deep sulcus sign (+) pada posisi supinasi
4. Peningkatan kerapatan coracan
bronchovaskular
Tipe : Primary (terjadi pada paru yang normal) & Secondary (terjadi
pada paru yang sakit)
Tipe berdasarkan ada tidaknya shifting : Simple & Tension Pneumothorax

Etiology : Spontaneous, Traumatic, Penyakit yang menurunkan compliance,

meningkatkan stifness
Deep sulcus sign :
Perubahan posisi
Costophrenic sulcus menjadi
lebih inferior & lebih lusen
HYDROPNEUMOTHORAX

Hydropneumothorax adanya adanya udara dan jumlah cairan

(pleural fluid) yang abnormal pada pleura
Etiology : thoracentesis, trauma, surgery
 Gambatan radiologis
1. Bayangan lusen tanpa corakan paru
2. air fluid level (+)
3. Pleural sign pada daerah pneumothorax
 ATELEKTASIS

 atelectasis adalah berurangnya volume sebagian atau seluruh paru-paru.

Etiologi :
- obstuksi : Ca, inhalasi benda asing, infeksi, aneurysm aorta, pengentalan
mucus yang menggangu sekresi
- Non obstruksi : kompresi, adhesi, scarring, pneumothorax / efusi
 Tipe :
-Sub segmental / discoid  linier, biasanya pada base paru. Berhubungan dengn
deactivasi surfactant
-Compressive  biasanya karena efusi / pneumothorax yang mengompresi secara
pasif
-Obstructive  biasanya karena adanya massa / mucus plug. Ditandai dengan
adanya deviasi
Gambaran radiology :
Direct sign :
Peningkatan opasitas, dan corakan bronchovaskular ramai. Perubahan
posisi fisura interlobar,  tertarik ke arah atelectasis
Indirect sign :
1. Perubahan posisi hemidiafragma  terangkat ke atas
2. Perubahan posisi trachea dan jantung  tertarik ke arah atelectasis
3. Overinflate pada segmen / lobus / paru yang tidak atelectasis sbg
kompensasi peningkatan retrosternal clear space pd foto lateral
4. Penyempitan sela iga
5. Perubahan letak hilus
EFUSI PLEURA
Peningkatan volume cairan pada rongga pleura.
Etiologi :
1. peningkatan produksi : peningkatan tekanan hydrostatic karena
LVH, penurunan tekanan oncotic karena hypoalbumin,
peningkatan permeabilitas vaskuler karena inflamasi atau
reaksi hipersensitivitas.
2. Penurunan reabsorbsi : penurunan absorbs / drainase limfatik
karena obstruksi, penurunan tekanan intrapleural karena
atelectasis
 Tipe cairannya : Transudate & Exudate
Deteksi efusi pleura :
CT / USG  deteksi efusi minimal
Lateral decubitus  ± 15 -20 ml
Lateral xray  ± 75ml
PA / erect xray  ± 300ml

Gambaran radiologis :
1. Gambaran opak homogen
2. Meniscus sign (+)
3. Sudut costophrenic blunting (
(>75ml lateral / >300ml frontal)
4. Efusi massif  merubah posisi
jantung dan trachea menjauhi
efusi
FIBROSIS PARU
Gambaran radiologi :
Opak berbentuk linier, yang
bukan berasal dari coracan
bronkovaskular
EDEMA PULMONAL