MORNING REPORT

JUNE 28TH 2019

Coass in charge:
Dyah Anisa Aprilani
Nadya Rasty Andhira

Supervisor:
dr. Dini Rachma Erawati, Sp. Rad (K)
Patient

No. Name Age Imaging Indication

1 Mr. R 73 yo Thorax AP Lung Tumor Post Evacuation
2 Mr. I 62 yo Thorax AP NSTEMI ACS
3 Mrs. F 68 yo Thorax AP Pneumoniae + COPD
4 Mr. S 68 yo Thorax AP/Lat Lung Tumor Dextra
5 Mrs. S 28 yo Thorax AP Post SCTP, Post CVC
6 Mr T Thorax PA
7 Thorax AP/Lat
CASE 1
Name : Mr. R
Age : 73 yo
Photo : Thorax AP
Indication : Lung Tumor Post Evacuation
Thorax AP
Thorax AP

Opacity on the left hemithorax covering the left heart, left hemidiaphragma, left
costophrenicus angle, narrowing intercostal space

•Cor: Attracted to the left, left heart border hard to evaluate

•Aorta: hard to evaluate
•Trachea : in the left
•Pulmo D : normal vascular pattern, normal hilus D
infiltrate (-), cavity (-), nodule (-)
•Costophrenic angle D : Sharp
•Hemidiaphragm D: Dome shaped
•Bones: intact, no lytic lesion or blastic lesion or fracture line
•Soft tissue: normal

•Conclusion:
- Pleural Effusion Sinistra with atelectasis component inside, the possibility
there is a mass cannot be removed
Pleural Effusions
 Pleural effusions, the result of the accumulation of fluid in the pleural space
 Normally, pleural fluid in pleural cavity amount 1-20 ml
 Many patients have no symptoms at the time a pleural effusion
is discovered. Possible symptoms include pleuritic chest pain,
dyspnea, and a dry, nonproductive cough.
 Pleural Effusion Types of
• Subpulmonic
• Free-flowing
• Laminar
• Loculated
• Fissural (pseudotumor)
Atelectasis
 Loss of lung volume
 Types of :
 Resorptive (obstructive)
 Passive (compressive)
 Adhesive (subsegmental)
 Cicatrization (scarring)
 Direct Sign
• Displacement of Interlobular fissures
 Indirect Signs
• Increase in lung density
• Elevation of the hemidiaphragm
• Mediastinal shift
• Compensatory overinflation
• Approximation of ribs
CASE 4
Name : Mr. MS
Age : 68 yo
Photo : Thorax AP/lat D
Indication : lung tumor
Thorax AP/lat D
Thorax AP/lat D

•Cor : site, shape and size normal

•Aorta : elongation(-), dilatation(-), calcification(+)
•Trache : in the middle
•Pulmo D : vascular pattern normal. Hillus normal. Cavity (+) with
thick wall, iregular, rounded with air fluid level with silhouette sign on
the basal right lung
S : vascular pattern normal. Hillus normal
•Costophrenic angle D/S : Sharp
•Hemidiaphragm D/S: Dome shaped
•Bones : intact, no lytic lesion or blastic lesion or fracture line
•Soft tissue : normal

•Conclusion:
- Abscess right lung
- Aorta sklerosis
 Lung Absess
Lung abscess is defined as a circumscribed area of pus or necrotic debris in lung
parenchima, which leads to a cavity, and after formation of bronchopulmonary
fistula, an air-fluid level inside the cavity
 By etiology:
 Primary (aspiration of oropharyngeal secretions, necrotizing pneumonia,
immunodeficiency);
 Secondary (bronchial obstructions, haematogenic dissemination, direct
spreading from mediastinal infection, from subphrenium, coexisting lung
diseases);
 Way of spreading:
 Brochogenic (aspiration of oropharyngeal secretions, bronchial obstruction by
tumor, foreign body, enlarged lymph nodes, congenital malformation);
 Haematogenic (abdominal sepsis, infective endocarditis, septic
thromboembolisms).
Imaging Findings
 Usually single cavity
 Cavities typically have a
 Thick-wall (which may become thinner as the surrounding
inflammation resolves)
 Smooth inner margin
 Air-fluid level
 More frequent in superior segments of lower lobes or
posterior segments of lower lobes
 Unlike pleural collections, lung abscesses frequently have a
fluid level which is approximately the same length on both
the frontal and lateral projection
 About 1/3 may have an associated empyema
CASE 6
Name : Mr. W
Age : 60 yo
Photo : Thorax AP
Indication : Ascites + renal failure + liver
failure
Thorax AP
Thorax AP

Opacity on the right and left hemithorax covering the right and left hemidiaphragma,
right and left costophrenicus angle on the half hemithorax dextra sinistra with minor
fissure thickness

•Cor: size enlarge

•Aorta: elongation(-), dilatation(-), calcification(-)
•Trachea: in the middle
•Pulmo D/S: increased vascular pattern with perivascular infiltrate
•Costophrenic angle D/S : hard to evaluate
•Hemidiaphragm D/S : hard to evaluate
•Bones: intact, no lytic lesion or blastic lesion or fracture line
•Soft tissue: normal

•Conclusion:
- Edema pulmonum
- Cardiomegaly
- Bilateral pleural effusion
Pulmonary Edema
 Increase in the fluid in the lung Generally, divided into cardiogenic and non-cardiogenic
categories
 Congestive heart failure is the leading diagnosis in hospitalized patients older than 65
 Cardiogenic pulmonary edema.
 Heart failure
 Coronary artery disease with left ventricular failure.
 Cardiac arrhythmias
 Fluid overload -- for example, kidney failure.
 Cardiomyopathy
 Obstructing valvular lesions -- for example, mitral stenosis
 Myocarditis and infectious endocarditis
 Non-cardiogenic pulmonary edema -- due to changes in capillary permeability
 Smoke inhalation.
 Head trauma
 Overwhelming sepsis.
 Hypovolemia shock
Imaging Findings
 The key findings of cardiogenic pulmonary edema Kerley B lines (septal lines)
 Seen at the lung bases, usually no more than 1 mm thick and 1 cm long, perpendicular to
the pleural surface
 Pleural effusions
 Usually bilateral, frequently the right side being larger than the left
 If unilateral, more often on the right
 Fluid in the fissures
 Thickening of the major or minor fissure
 Peribronchial cuffing
 Visualization of small doughnut-shaped rings representing fluid in thickened bronchial
walls
 Collectively, the above four findings comprise pulmonary interstitial edema
 The heart may or may not be enlarged
 When the fluid enters the alveoli themselves, the airspace disease is typically
diffuse, and there are no air bronchograms
THANK YOU