2. THORAX
Transcript of 2. THORAX
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THORAXdr. Hendro S., Sp.RFK Universitas Wijaya Kusuma
Surabaya
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METODE PEMERIKSAAN RÖ
1. Foto Polos : - PA, Lat - AP, Dekubitus, Obliue !a"i#$
%. TOMO&RAFI
'. (T S(AN). *S&
+. Raio#ulie
. !"o#/o$"a0i
. A#$io$"a0i
2. M.R.I
3. Li40a#$io$"a0i
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PEMERIKSAAN 5 READIN&FOTO T6ORA7
1. IDENTITAS PEND.%. TEKNIK RADIO&RAFI'. MEDIK :
1. PAR*%. 8ANT*N& 5 MEDIAST'. DIAFRA&MA
). PLE*RA+. T*LAN&. SOFT TISS*E
. S*!-DIAFRA&MA
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IDENTITAS PEND.
- Na4a
- *4u"
- Se9- Ala4at
- Ta#$$al Pe4e"iksaa#
- Kete"a#$a# Kli#ik
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TEKNIK RADIO&RAFI
- Foto a#$ baik 5 sta#a" a. Pe#. be"i"i te$ak
b. I#s;i"asi ala4. Ma"ke" R <ka#a#= 5 L <ki"i=. Tiak $oa#$
e. Posisi PA0. 8a"ak su4be" si#a" ke ;e#$. Se#t"asi > ? @.T/.)-+
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PAR*
- !a#i#$ka# ka#a# ki"i- (o"aka# b"o#/oBaskula" -
De#sitas ;a"e#/i4- Kelai#a#-kelai#a# :C Lokal
C i0useC u#ilate"al 5 bilate"al- I#s;i"asi uku;
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8ANT*N& MEDIASTIN*M
a. 8ANT*N&- !e#tuk
- !esa" 5 uku"a#- Posisi < De9t"oa"ia=b. MEDIASTIN*M
- A#te"io" - Meial- Poste"io"
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MEDIASTIN*M
A#te"io" : 1,%,'
Meial : )
Poste"ios : +,,
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MEDIAST. ANT1. 1. A#eu"is4a Ao"ta
%. Pe4besa"a# Kele#a" '. Ret"oste"#al &oite" ). Fat e;ositio#
%. - Pe4besa"a# kele#a" - T/4o4a- Tu4o" &e"4 (ell- A#eu"is4a Ao
'. - Fat ;a- Kista ;leu"o ;e"ia"ial- Dia0"a$4a /u4;
- 6e"#ia MOR&A&NI
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MEDIAST. MEDI*S). - Pe4besa"a# kele#a"
- A#eu"is4a Ao
- Pe4besa"a# A. Pul4o#a"
- Dilatasi @. (aBa Su;e"io" - Kista !"o#ko$e#ik
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MEDIAST. POSTERIOR+. - Neu"o$e#i tu
- P/a"#$o eso;/. ;ou/. - 6iatus /e"#ia
- A#eu"is4a Ao- Dilatasi Oeso;/a$us- Dilatasi @. A$os- Tu. (a"ia
. - Neu"o$e#i tu- Tu. Pa"aBe"teb"al- 6e"#ia !o/alek
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DIAFRA&MA- !e#tuk kuba/-
Ka#a# lebi/ ti#$$i a"i;aa ki"i- (osta ka#a# e;a# 4e4oto#$ ;e"te#$a/a#ia0"a$4a ka#a#
ELE@ASI DIAFR. SIMETRIS !ILATERAL :
- Posisi su;i#asi- I#s;i"asi ku"a#$ ala4- Obesitas
- 6a4il- Kesakita# <;ost o;.=- Pa"alisis bilate"al- Fib"osis ;a"u i0use
- Diste#si abo4i#al <asites, Tu Ab-ileus=
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ELE@ASI DIAFR. *NILAT- Postu"e 5 Posisi eubitus
- Skoliosis Be"t.- Palsi Ne"Bus P/"e#ius- Kesakita# <F"aktu" "ib=
- Kelai#a# ;a"u : C /i;o;lasiC ;#eu4o#iaC kola;sitas
C e4boli- Kelai#a# Pleu"a : C e0usi ;leu"a
C i#0eksi sub;/"e#i
C tu4o" sub;/"e#i
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ELE@ASI FOKAL DIAFR<!*L&IN&=
6e"#ia ia0"a$4atika
Tu4o" ia0"a$4a
Tu4o" ;leu"a Tu4o" ;a"u
Dis0u#$si 0okal ia0"a$4atik
Aesi 0okal ia0"a$4a
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PLE*RAt. : - Pleu"a @ise"alis
- Pleu"a Pa"ietalis(ai"a# ;leu"a
- No"4al : +-1+ 4l
- Patolo$ist :1 : Lat ekubitus ta4;ak
%+ : ;osisi be"i"i PA
;. Si#us osto;/"e#ius Lat< ;e#elitia# : G1+ 4l RLD t/o"a9, ta4;ak e00.;leu"a=
- Mula-4ula 4e#$isi si#us .;. ;ost ke4uia#Lat, ke4uia# A#t
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PLE*RAL EFF*SION(ai"a# ;leu"a :
!ila ;"ouksi G"eso";siP"ouksi ;aa :1. Pe tek. Mik"oBaskula" ;a"u <;aa $a$al
a#tu#$=%. Pe tek o#kotik ;las4a <4is : /i;o
;"otei#e4ia='. Pe ;e"4eabilitas 4ik"oBaskula" <4is :
;leu"is=). Pe L4;/ati "ai#a$e a"i "ua#$ ;leu"a<4is : Li40a#$itis=
+. Passa$e ;e"ito#eal 0lui bila aa e0et
ia0"a$4a
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(AIRAN DALAM R*AN&PLE*RAL
T"a#suat E9uat Pus
Da"a/ (/leSea"a RÖ sulit ibeaka#DD H ;e"lu ata lai# Ket. Kli#is Kel. Lai# ala4 T/o"a9
<(a"io4e$ali, F"atu"a i$a, ll=
!io;si ;leu"a
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T6ORA7 PAE0usi Pleu"a :
Pe"4ukaa# ai"a# lat lebi/ ti#$$i a"i;aa4eial ka"e#a elastisitas ;a"u ba$ late"allebi/ besa" a"i;aa 4eial
E0usi ;leu"a ;okete- !e#tuk ;u. Eli;s- Dala4 "ua#$ a#ta" se$4e# 5 i#te" lobus 5
tissu"a- DD : C kel. E9t"a;leu"alC kel. ala4 ;a"e#/i4 ;a"u
C Tu4o" 4eiasti#u4
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PNE*MOT6ORA7 Aa#a ua"a ala4 "ua#$ ;leu"a
(ausa : e0et ;leu"a
: Bis ;a"ietalis
4is : - kel. Pa"u
- t"au4a t/o"a9
- s;o#ta#
- a"ti0iial
S;o#ta#, ok
- !"o#/itis k"o#ik - Ru;tu" kaBitas
- E40ise4a - ll
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PENE!ALAN PLE*RA- !ilate"al- *#ilate"al1. !ILATERAL PLE*RAL T6I(K
- o"a#$ la#ut usia ;u. i ae"a/ a;e9
k4k ok is/e4ia%. *NILAT PLE*RAL T6I(KENIN&
- A;e9 : Tu4o" Pa#oast
- E9te#si0 :C e0usi ;leu"a a#$ 4e#$ala4io"$a#isasi
C bekas e4;e4a
Pleu"al Fib"osis
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KALSIFIKASI PLE*RA
Kela#uta# a"i 0ib"osis ;leu"a- *#ilat. Kalsi0 Pleu"a :
- E0usi Pleu"a
- E4;e4a- 6e4ot/o"a9
- !ilat. Kalsi0 Pleu"a :
- Asbestosis
- P#eu4oo#iosis
- E0usi Pleu"a !ilat.
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T*MOR PLE*RA1. - P"i4e"
- Seku#e" %. - 8i#ak
- &a#as8i#ak : - Fib"o4a
- Li;o4a&a#as : - PRIMER MESOTELIOMA
C be"/ub. e#$a# AsbestosC ;e#ebala# ;leu"a 4assa ;leu"aC DD. Tu. Pa"u- SEK*NDER :C 4etastase a"i te4;at lai# : 4a44ae
ll
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INFEKSI PAR*1. PNE*MONIA AK*T
- !akte"ialC St"e;toous ;#eu4o#iaeC Sta;/loous au"eus
C Klebsiella ;#eu4o#iaeC Le$io##aiBeJs iseaseC 6ae4o;/llus i#0lue#ae
- &"a4C Ne$atiBe ;#eu4o#iaC Pseuo4o#as ae"u$i#osaC E. oli
C Tula"ae4ia
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T*!ER(*LOSIS PAR*
PENE!A! :- Mobate"iu4 tb 3+- Mobate"iu4 ati;ik +MORFOLO&I 5SIFAT :- Ku4a# btk bata#$, #o#-4otil
- Tiak 4e4be#tuk s;o"a- Tu4bu/ o;ti4al ;aa su/u '- !asil ta/a# asa4
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T*!ER(*LOSIS PAR*
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PATO&ENESIS T! PAR* Pe#ula"a# Bia ua"a - "o;let #ulei te"/isa;
o"a#$ se/at - 4asuk siste4 ;e"#a0asa# - sa4;aialBeoli Diala4 alBeoli : aa siste4 ;e"ta/a#a#
tubu/5aitu 4a"o;/a$e
O"a#$ e#$a# i4u#itas baik :- Ku4a# ilokalisi" K4 : 4atiAtau : ia4 ta#;a $eala
O"a#$ e#$a# i4u#itas elek :- 4a"o;/a$e Kala/ P"oses e9uati0 Sa"a#$ ;#eu4o#i
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KEM*N&KINAN KEM*N&KINAN
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KEM*N&KINAN-KEM*N&KINANDARI FOK*S PRIMER DI
AL@EOLI1. Se4bu/ ta#;a bekas
%. Se4bu/ e#$a# bekas
'. Me#eba" e#$a# e0ek la#ut :
a.Pe#eba"a# ;e"ko#ti#uitatu4 ke
;a"e#ki4 ;a"u sekita" ke ;leu"ab.Pe#eba"a# b"o#/o$e# ke ;a"ui;silate"al ke ;a"u ko#t"alate"al
te"tela# ke usus tb usus
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FOTO T6ORA7 PD T!( PAR*5K.P < Ko/ Pul4o#u4=
Posisi Sta#a" : PA I#te"al
Pe#ilaia# :
1. Pa"e#/i4 ;a"u%. K&! : - 6ilus
- Meiasti#u4
'. Salu"a# *a"a5 T"a/eo b"o#/ialt"ee
). Pleu"a
T! PAR* POST PRIMER
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T! PAR* POST PRIMER
1. E9uati0 Lokal
%. Fib"o P"oukti0 Lokal
'. Pe4be#tuka# KaBitas
). P#eu4o#ia T!( akut Pe#eba"a# !"o/o$e#
+. T!( 4ilie"
. !"o/ietasis Tb
T! PAR* POST PRIMER
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T! PAR* POST PRIMER
. !"o#/o Ste#osis Tb
2. Tube"kulo4a
3. Pleu"al E00usio#1. Fistula !"o#/o;leu"a E4;e4a
11. Fib"ot/o"a9 a#$ 4e#$ala4iKalsi0ikasi
1%. Pe"ia"itis (o#st"itiBa
P t i T b k l i
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Pato$e#esis Tube"kulosisI#/alasi basil T! AlBeolus Fa$ositosis
ole/ 4ak"o0a$
Dest"uksi basil T!
!asil T! be"ke4ba#$ biak
Dest"uksi 4ak"o0a$
Pe4be#tuka# Tube"kel Kele#a" Li40e
Pe#eba"a#/e4ato$e#
Lesi i /e;a", lie#,
$i#al, tula#$, otak, ll
Pe"kiua#
Pea/
Lesi Seku#e"
Pa"u
Resolusi
Kalsi0ikasi
Ko4;leks
&/o#
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(AR(INOMA PAR*
Etiolo$i : !elu4 elas
Fakto"-0akto" :
ba/a# ka"si#o$e#ik- 4aa4-4aa4
- u4la/#a
- 4eka#is4e ko4;leks :
i#te"aksi
si#e"$istik e0ek
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Si0at-si0at ba/a# ka"si#o$e#ik :- I#itiato"
- Moi0ikasi $e#eti a;;a"atus- Me#o"o#$ ;ote#si sel 4e#ai tu4o" - P"o4oto"
!a/a#-ba/a# ka"si#o$e#ik 5 ;"eis;osisi :- Te4bakau- Polusi ua"a <a"se#, /"o4, #ikel,
4i#ak ta#a/, ll=- Ke;aata# ;e#uuk sos-eko# a#$
elek
- Pe#akit ;a"u k"o#ik
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PENE!ARAN (A-PAR*A. 6e4ato$e#
4e"u;aka# ;e#eba"a# uta4a
ke : /e;a", "e#, tula#$, otak 4e#i#$e#,/i;o0ise
!. L4;/ati
- te"uta4a ke kele#a" &! sekita" ;a"u
4eiasti#u4- K&! ;a"a oeso;/a$eal
- K&! ;a"a ao"ti
- K&! ;a"a "e#al
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KLINIS (A-PAR*
(e;at atau la4bat
Te"$a#tu#$ :
1. lokasi tu4o" ;"i4e" %. t;e /istolo$i
'. kee;ata# tu4bu/
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&eala aQal :
1. !atuk : s;utu4 /e4o""/a$is 4uoi
%. /eei#$ ;aa u4u4#a u#ilat'. Obst"ukti0 ;#eu4o#itis
). Ds;#oe
+. (/est ;ai#
. De4a4 "i#$a#
. A#o"e9ia 5 !!
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&eala la#ut :
- s ;/a$ia
- s ;/o#ia- Be#a aBa su;. si#"o4e
- ko4;"esi ;ulus su;. tu ;aa ;le9.
b"a/ialis #e"i- 4etastase /i;o0ise ;ost iabetes
i#si;ius
- 4a#i0estasi siste4 sa"a0
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DIA&NOSA (A-PAR*
1. &eala kli#ik
%. Tek#ik i4a$i#$ :
- 0oto t/o"a9 ;olos- to4o$"a0i
- (T sa#
- *S&- a#$io$"a0i
- si#ti$"a0i
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'. !"o#/osko;i
). Sitolo$i
+. !io;si. Meiasti#oso;
. T/o"aoso;
2. Labo"ato"iu4
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PATOLO&I
Klasi0ikasi /istolo$i (a ;a"u 4e#u"ut 6O :I. S*AMO*S (ELL (A
A. s;i#le ell
Ba"ia# o0 sua4ous ell (a
II. SMALL (ELL (A
A. Oat ell (a <L4;/ote like=!. I#te"4eiate t;e <;ol$o#al t;e=
(. (o4bi#e oat ell (a
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III. ADENO (A
A. Ai#a"
!. !"o#/o alBeola" (a(. Pa;illa"
D. Soli t;e, 4ui# ;ositiBe
I@. LAR&E (ELL (A
A. &ia#t ell subt;e
!. (lea" ell subt;e@. ADENO S*AMO*S (ELL (A
O O O
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FOTO T6ORA7 :
1. o;asitas 4assa
%. ;e4besa"a# /ilus'. e#sitas li#ie" 5 #oula" a#$ be"batas
tak elas
). atelektasis 5 ko#soliasi+. loba" e40ise4a
. oi# lesio#
. aBitas
2. kalsi0ikasi