Resolusi tinggi dihitungtomografi (CT) scan menunjukkaninter-dan intralobar garis septum mendominasidi bagian anteriorbidang paru kiri dengan beberapa peribronchialmemborgol (panah) Kedua paru menampilkandaerah tanah-kaca difus meningkatatenuasi dengan gravitasigradien anteroposterior

CT Scan toraks juga dapat membantu dalam diagnosa dan dapat digunakan untuk mengevaluasi perbaikan dari edema paru

CT-Scan resolusi tinggi dapat menunjukkan konsolidasi wilayah udara luasyang mungkin memiliki distribusi yang dominan di daerah paru-paruSebuah pola retikuler dengan distribusi anterior mencolok sering ditemuin padaCT-Scan pada penderita ARDS hal ini terkait dengan durasi tekanan-dikendalikanventilasi invers-rasio5

(3) Bat wing edema in a 71-year-old woman with fluid overload and cardiac failure Chest radiograph(a) and high-resolution CT scan (b) demonstrate bat wing alveolar edema with a central distribution and

sparing of the lung cortex The infiltrates resolved within 32 hours (4) Bat wing edema in a 66-year-old womanwith fluid overload of renal origin who was undergoing hemodialysis for hypertensive nephroangiosclerosisThe patient was found unconscious after lying on her right side for several hours Chest radiograph shows unusualrecumbent bat wing pulmonary edema with associated right-sided pleural effusion

(3) Bat sayap edema pada wanita 71 tahun dengan overload cairan dan gagal jantung rontgen dada(a) dan resolusi tinggi CT scan (b) menunjukkan kelelawar sayap alveolar edema dengan distribusi sentral danhemat dari korteks paru-paru Infiltrat diselesaikan dalam waktu 32 jam (4) Bat sayap edema pada wanita 66 tahundengan overload cairan asal ginjal yang menjalani hemodialisis untuk nephroangiosclerosis hipertensiPasien ditemukan tak sadarkan diri setelah berbaring di sisi kanannya selama beberapa jam Rontgen dada menunjukkan tidak biasatelentang bat wing edema paru dengan terkait sisi kanan efusi pleura

Abnormalities visible on high-resolution CT scans includedareas of ground-glass opacity (six patients) interlobular septalthickening (five patients) penibronchovascular interstitial thickening(five patients) increased vascular caliber (four patients)and pleural effusion or thickening of fissures (four patients)In three patients high-resolution CT scans obtained aftertherapy showed improvement of the abnormalities

(Kelainan terlihat pada resolusi tinggi CT scan disertakanbidang opacity tanah-kaca (enam pasien) interlobular septumpenebalan (lima pasien) penebalan interstitial penibronchovascular(lima pasien) peningkatan kaliber pembuluh darah (empat pasien)dan efusi pleura atau penebalan fisura (empat pasien)Dalam tiga pasien resolusi tinggi CT scan diperoleh setelahterapi menunjukkan perbaikan dari kelainan

Fig 6-66-year-old woman with mitralregurgitation resulting from myocardial infarctionand papillary muscle ruptureA and B Ground-glass opacities interlobularseptal thickening and peribronchovascularinterstitial thickening are predominant in rightupper(A) and right middle(B) lobes Thickeningof right major fissure is also present (B) Unilateralpulmonary edema abnormalities localizedto right upper lobe can be observed in patientswith mitral valve insufficiency especially if secondaryto papillary muscle rupture

Gambar Wanita 6-66 tahun dengan mitralregurgitasi akibat infark miokarddan ruptur otot papilerA dan B kekeruhan tanah-kaca interlobularpenebalan septum dan peribronchovascularpenebalan interstitial yang dominan dalam dirinyaatas (A) dan tengah kanan (B) lobus penebalanfisura utama yang tepat juga hadir (B) sepihakkelainan edema paru terlokalisasike lobus kanan atas dapat diamati pada pasiendengan insufisiensi katup mitral terutama jika sekunderuntuk papiler otot pecah

Prone high-resolution CT scans atlung bases in 70-year-old woman with mitralinsufficiency and congestive heart failure

A and B Thickened interlobular septa equivalentto Kerley B lines seen on plain radiographsare most numerous and of greatest width independent lung These range up to several mm inthickness Focal nodularity of septa at branchingpoints reflects presence of pulmonary veinsPeribronchovascular interstitial thickening isalso evident (A) Centrilobular arteries are prominent(arrows in B) Incidentally noted are areas ofminimal centrilobular emphysema (A and B)Rawan resolusi tinggi CT scan pada basis paru-paru pada wanita 70 tahun dengan mitral insufisiensi dan gagal jantung kongestif A dan B Kental septa interlobular setara Kerley B ke garis terlihat pada radiografi polos paling banyak dan lebar terbesar dalam paru dependen Ini berkisar hingga beberapa mm ketebalan Nodularity Focal septa pada percabangan poin mencerminkan adanya pembuluh darah paru Penebalan interstitial peribronchovascular adalah juga jelas (A) Arteri centrilobular yang menonjol (Panah di B) Kebetulan dicatat adalah daerah emfisema centrilobular minimal (A dan B)

HRCT findings in cardiogenic pulmonary edema

Bilateral septal thickening and ground-glass opacity Perihilar and gravitational distribution predominatly in the

dependent lung Cardiomegaly and pleural fluid

On the left typical features of cardiogenic pulmonary edemaThere is smooth septal thickening and some ground glass opacity in the dependent part of the lungsIn addition there is bilateral pleural fluidIn a patient with a known malignancy lymphangitic carcinomatosis would be high in the differential diagnostic list

Differential diagnosis of cardiogenic pulmonary edema

Lymphangitic carcinomatosis Interstitial pneumonia (viral mycoplasma) ARDS Pulmonary hemorrhage

On the left another example of cardiogenic pulmonary edemaThis patient had a CT to rule out pulmonary emboliThere is smooth septal thickening and ground glass opacity in a more patchy distribution

Note edema can have a very unusual appearance and be distributed very patchy some areas are filled with fluid as opposed to other areas in immediate vicinity which appear normal

ldquoground glass appearancerdquo atau titik-titik halus di basis paru-paru dengan batas jantung dan diafragma yang tidak jelas

CT Scan digunakan di dalam kedokteran sebagai alat diagnostik dan sebagai pemanduuntuk prosedur intervensi Kadang-kadang membandingkan material seperti kontrasyang diodinasi kedalam pembuluh darah Ini berguna bagi menyoroti struktur sepertipembuluh darah yang jika tidak akan sukar untuk menggambarkan jaringan sekitarnyaPenggunaan material kontras dapat juga membantu ke arah memperoleh informasifungsional tentang jaringantisu

Gluecker T Capasso P Schnyder P Gudinchet F Schaller MD Revelly JP Chiolero R Vock P Wicky S 1999 Clinical and Radiologic Features of Pulmonary Edema Scientific Exhibit Volume 19 Number 6pp 1508-31

Smithuis R Delden OV Schaefer C 2007Lung-HRCT-Common Diseases Radiology Department of the Rijnland Hospital Leiderdorp and the Academical Medical Centre Amsterdam the Netherlands httpwwwradiologiassistantlung-hrct-common-diseaseshtml (diakses pada 10 april 2013)

sparing of the lung cortex The infiltrates resolved within 32 hours (4) Bat wing edema in a 66-year-old womanwith fluid overload of renal origin who was undergoing hemodialysis for hypertensive nephroangiosclerosisThe patient was found unconscious after lying on her right side for several hours Chest radiograph shows unusualrecumbent bat wing pulmonary edema with associated right-sided pleural effusion

(3) Bat sayap edema pada wanita 71 tahun dengan overload cairan dan gagal jantung rontgen dada(a) dan resolusi tinggi CT scan (b) menunjukkan kelelawar sayap alveolar edema dengan distribusi sentral danhemat dari korteks paru-paru Infiltrat diselesaikan dalam waktu 32 jam (4) Bat sayap edema pada wanita 66 tahundengan overload cairan asal ginjal yang menjalani hemodialisis untuk nephroangiosclerosis hipertensiPasien ditemukan tak sadarkan diri setelah berbaring di sisi kanannya selama beberapa jam Rontgen dada menunjukkan tidak biasatelentang bat wing edema paru dengan terkait sisi kanan efusi pleura

Abnormalities visible on high-resolution CT scans includedareas of ground-glass opacity (six patients) interlobular septalthickening (five patients) penibronchovascular interstitial thickening(five patients) increased vascular caliber (four patients)and pleural effusion or thickening of fissures (four patients)In three patients high-resolution CT scans obtained aftertherapy showed improvement of the abnormalities

(Kelainan terlihat pada resolusi tinggi CT scan disertakanbidang opacity tanah-kaca (enam pasien) interlobular septumpenebalan (lima pasien) penebalan interstitial penibronchovascular(lima pasien) peningkatan kaliber pembuluh darah (empat pasien)dan efusi pleura atau penebalan fisura (empat pasien)Dalam tiga pasien resolusi tinggi CT scan diperoleh setelahterapi menunjukkan perbaikan dari kelainan

Fig 6-66-year-old woman with mitralregurgitation resulting from myocardial infarctionand papillary muscle ruptureA and B Ground-glass opacities interlobularseptal thickening and peribronchovascularinterstitial thickening are predominant in rightupper(A) and right middle(B) lobes Thickeningof right major fissure is also present (B) Unilateralpulmonary edema abnormalities localizedto right upper lobe can be observed in patientswith mitral valve insufficiency especially if secondaryto papillary muscle rupture

Gambar Wanita 6-66 tahun dengan mitralregurgitasi akibat infark miokarddan ruptur otot papilerA dan B kekeruhan tanah-kaca interlobularpenebalan septum dan peribronchovascularpenebalan interstitial yang dominan dalam dirinyaatas (A) dan tengah kanan (B) lobus penebalanfisura utama yang tepat juga hadir (B) sepihakkelainan edema paru terlokalisasike lobus kanan atas dapat diamati pada pasiendengan insufisiensi katup mitral terutama jika sekunderuntuk papiler otot pecah

Prone high-resolution CT scans atlung bases in 70-year-old woman with mitralinsufficiency and congestive heart failure

A and B Thickened interlobular septa equivalentto Kerley B lines seen on plain radiographsare most numerous and of greatest width independent lung These range up to several mm inthickness Focal nodularity of septa at branchingpoints reflects presence of pulmonary veinsPeribronchovascular interstitial thickening isalso evident (A) Centrilobular arteries are prominent(arrows in B) Incidentally noted are areas ofminimal centrilobular emphysema (A and B)Rawan resolusi tinggi CT scan pada basis paru-paru pada wanita 70 tahun dengan mitral insufisiensi dan gagal jantung kongestif A dan B Kental septa interlobular setara Kerley B ke garis terlihat pada radiografi polos paling banyak dan lebar terbesar dalam paru dependen Ini berkisar hingga beberapa mm ketebalan Nodularity Focal septa pada percabangan poin mencerminkan adanya pembuluh darah paru Penebalan interstitial peribronchovascular adalah juga jelas (A) Arteri centrilobular yang menonjol (Panah di B) Kebetulan dicatat adalah daerah emfisema centrilobular minimal (A dan B)

HRCT findings in cardiogenic pulmonary edema

Bilateral septal thickening and ground-glass opacity Perihilar and gravitational distribution predominatly in the

dependent lung Cardiomegaly and pleural fluid

On the left typical features of cardiogenic pulmonary edemaThere is smooth septal thickening and some ground glass opacity in the dependent part of the lungsIn addition there is bilateral pleural fluidIn a patient with a known malignancy lymphangitic carcinomatosis would be high in the differential diagnostic list

Differential diagnosis of cardiogenic pulmonary edema

Lymphangitic carcinomatosis Interstitial pneumonia (viral mycoplasma) ARDS Pulmonary hemorrhage

On the left another example of cardiogenic pulmonary edemaThis patient had a CT to rule out pulmonary emboliThere is smooth septal thickening and ground glass opacity in a more patchy distribution

Note edema can have a very unusual appearance and be distributed very patchy some areas are filled with fluid as opposed to other areas in immediate vicinity which appear normal

ldquoground glass appearancerdquo atau titik-titik halus di basis paru-paru dengan batas jantung dan diafragma yang tidak jelas

CT Scan digunakan di dalam kedokteran sebagai alat diagnostik dan sebagai pemanduuntuk prosedur intervensi Kadang-kadang membandingkan material seperti kontrasyang diodinasi kedalam pembuluh darah Ini berguna bagi menyoroti struktur sepertipembuluh darah yang jika tidak akan sukar untuk menggambarkan jaringan sekitarnyaPenggunaan material kontras dapat juga membantu ke arah memperoleh informasifungsional tentang jaringantisu

Gluecker T Capasso P Schnyder P Gudinchet F Schaller MD Revelly JP Chiolero R Vock P Wicky S 1999 Clinical and Radiologic Features of Pulmonary Edema Scientific Exhibit Volume 19 Number 6pp 1508-31

Smithuis R Delden OV Schaefer C 2007Lung-HRCT-Common Diseases Radiology Department of the Rijnland Hospital Leiderdorp and the Academical Medical Centre Amsterdam the Netherlands httpwwwradiologiassistantlung-hrct-common-diseaseshtml (diakses pada 10 april 2013)

Fig 6-66-year-old woman with mitralregurgitation resulting from myocardial infarctionand papillary muscle ruptureA and B Ground-glass opacities interlobularseptal thickening and peribronchovascularinterstitial thickening are predominant in rightupper(A) and right middle(B) lobes Thickeningof right major fissure is also present (B) Unilateralpulmonary edema abnormalities localizedto right upper lobe can be observed in patientswith mitral valve insufficiency especially if secondaryto papillary muscle rupture

Gambar Wanita 6-66 tahun dengan mitralregurgitasi akibat infark miokarddan ruptur otot papilerA dan B kekeruhan tanah-kaca interlobularpenebalan septum dan peribronchovascularpenebalan interstitial yang dominan dalam dirinyaatas (A) dan tengah kanan (B) lobus penebalanfisura utama yang tepat juga hadir (B) sepihakkelainan edema paru terlokalisasike lobus kanan atas dapat diamati pada pasiendengan insufisiensi katup mitral terutama jika sekunderuntuk papiler otot pecah

Prone high-resolution CT scans atlung bases in 70-year-old woman with mitralinsufficiency and congestive heart failure

A and B Thickened interlobular septa equivalentto Kerley B lines seen on plain radiographsare most numerous and of greatest width independent lung These range up to several mm inthickness Focal nodularity of septa at branchingpoints reflects presence of pulmonary veinsPeribronchovascular interstitial thickening isalso evident (A) Centrilobular arteries are prominent(arrows in B) Incidentally noted are areas ofminimal centrilobular emphysema (A and B)Rawan resolusi tinggi CT scan pada basis paru-paru pada wanita 70 tahun dengan mitral insufisiensi dan gagal jantung kongestif A dan B Kental septa interlobular setara Kerley B ke garis terlihat pada radiografi polos paling banyak dan lebar terbesar dalam paru dependen Ini berkisar hingga beberapa mm ketebalan Nodularity Focal septa pada percabangan poin mencerminkan adanya pembuluh darah paru Penebalan interstitial peribronchovascular adalah juga jelas (A) Arteri centrilobular yang menonjol (Panah di B) Kebetulan dicatat adalah daerah emfisema centrilobular minimal (A dan B)

HRCT findings in cardiogenic pulmonary edema

Bilateral septal thickening and ground-glass opacity Perihilar and gravitational distribution predominatly in the

dependent lung Cardiomegaly and pleural fluid

On the left typical features of cardiogenic pulmonary edemaThere is smooth septal thickening and some ground glass opacity in the dependent part of the lungsIn addition there is bilateral pleural fluidIn a patient with a known malignancy lymphangitic carcinomatosis would be high in the differential diagnostic list

Differential diagnosis of cardiogenic pulmonary edema

Lymphangitic carcinomatosis Interstitial pneumonia (viral mycoplasma) ARDS Pulmonary hemorrhage

On the left another example of cardiogenic pulmonary edemaThis patient had a CT to rule out pulmonary emboliThere is smooth septal thickening and ground glass opacity in a more patchy distribution

Note edema can have a very unusual appearance and be distributed very patchy some areas are filled with fluid as opposed to other areas in immediate vicinity which appear normal

ldquoground glass appearancerdquo atau titik-titik halus di basis paru-paru dengan batas jantung dan diafragma yang tidak jelas

CT Scan digunakan di dalam kedokteran sebagai alat diagnostik dan sebagai pemanduuntuk prosedur intervensi Kadang-kadang membandingkan material seperti kontrasyang diodinasi kedalam pembuluh darah Ini berguna bagi menyoroti struktur sepertipembuluh darah yang jika tidak akan sukar untuk menggambarkan jaringan sekitarnyaPenggunaan material kontras dapat juga membantu ke arah memperoleh informasifungsional tentang jaringantisu

Gluecker T Capasso P Schnyder P Gudinchet F Schaller MD Revelly JP Chiolero R Vock P Wicky S 1999 Clinical and Radiologic Features of Pulmonary Edema Scientific Exhibit Volume 19 Number 6pp 1508-31

Smithuis R Delden OV Schaefer C 2007Lung-HRCT-Common Diseases Radiology Department of the Rijnland Hospital Leiderdorp and the Academical Medical Centre Amsterdam the Netherlands httpwwwradiologiassistantlung-hrct-common-diseaseshtml (diakses pada 10 april 2013)

A and B Thickened interlobular septa equivalentto Kerley B lines seen on plain radiographsare most numerous and of greatest width independent lung These range up to several mm inthickness Focal nodularity of septa at branchingpoints reflects presence of pulmonary veinsPeribronchovascular interstitial thickening isalso evident (A) Centrilobular arteries are prominent(arrows in B) Incidentally noted are areas ofminimal centrilobular emphysema (A and B)Rawan resolusi tinggi CT scan pada basis paru-paru pada wanita 70 tahun dengan mitral insufisiensi dan gagal jantung kongestif A dan B Kental septa interlobular setara Kerley B ke garis terlihat pada radiografi polos paling banyak dan lebar terbesar dalam paru dependen Ini berkisar hingga beberapa mm ketebalan Nodularity Focal septa pada percabangan poin mencerminkan adanya pembuluh darah paru Penebalan interstitial peribronchovascular adalah juga jelas (A) Arteri centrilobular yang menonjol (Panah di B) Kebetulan dicatat adalah daerah emfisema centrilobular minimal (A dan B)

HRCT findings in cardiogenic pulmonary edema

Bilateral septal thickening and ground-glass opacity Perihilar and gravitational distribution predominatly in the

dependent lung Cardiomegaly and pleural fluid

On the left typical features of cardiogenic pulmonary edemaThere is smooth septal thickening and some ground glass opacity in the dependent part of the lungsIn addition there is bilateral pleural fluidIn a patient with a known malignancy lymphangitic carcinomatosis would be high in the differential diagnostic list

Differential diagnosis of cardiogenic pulmonary edema

Lymphangitic carcinomatosis Interstitial pneumonia (viral mycoplasma) ARDS Pulmonary hemorrhage

On the left another example of cardiogenic pulmonary edemaThis patient had a CT to rule out pulmonary emboliThere is smooth septal thickening and ground glass opacity in a more patchy distribution

Note edema can have a very unusual appearance and be distributed very patchy some areas are filled with fluid as opposed to other areas in immediate vicinity which appear normal

ldquoground glass appearancerdquo atau titik-titik halus di basis paru-paru dengan batas jantung dan diafragma yang tidak jelas

CT Scan digunakan di dalam kedokteran sebagai alat diagnostik dan sebagai pemanduuntuk prosedur intervensi Kadang-kadang membandingkan material seperti kontrasyang diodinasi kedalam pembuluh darah Ini berguna bagi menyoroti struktur sepertipembuluh darah yang jika tidak akan sukar untuk menggambarkan jaringan sekitarnyaPenggunaan material kontras dapat juga membantu ke arah memperoleh informasifungsional tentang jaringantisu

Gluecker T Capasso P Schnyder P Gudinchet F Schaller MD Revelly JP Chiolero R Vock P Wicky S 1999 Clinical and Radiologic Features of Pulmonary Edema Scientific Exhibit Volume 19 Number 6pp 1508-31

Smithuis R Delden OV Schaefer C 2007Lung-HRCT-Common Diseases Radiology Department of the Rijnland Hospital Leiderdorp and the Academical Medical Centre Amsterdam the Netherlands httpwwwradiologiassistantlung-hrct-common-diseaseshtml (diakses pada 10 april 2013)

HRCT findings in cardiogenic pulmonary edema

Bilateral septal thickening and ground-glass opacity Perihilar and gravitational distribution predominatly in the

dependent lung Cardiomegaly and pleural fluid

On the left typical features of cardiogenic pulmonary edemaThere is smooth septal thickening and some ground glass opacity in the dependent part of the lungsIn addition there is bilateral pleural fluidIn a patient with a known malignancy lymphangitic carcinomatosis would be high in the differential diagnostic list

Differential diagnosis of cardiogenic pulmonary edema

Lymphangitic carcinomatosis Interstitial pneumonia (viral mycoplasma) ARDS Pulmonary hemorrhage

On the left another example of cardiogenic pulmonary edemaThis patient had a CT to rule out pulmonary emboliThere is smooth septal thickening and ground glass opacity in a more patchy distribution

Note edema can have a very unusual appearance and be distributed very patchy some areas are filled with fluid as opposed to other areas in immediate vicinity which appear normal

ldquoground glass appearancerdquo atau titik-titik halus di basis paru-paru dengan batas jantung dan diafragma yang tidak jelas

CT Scan digunakan di dalam kedokteran sebagai alat diagnostik dan sebagai pemanduuntuk prosedur intervensi Kadang-kadang membandingkan material seperti kontrasyang diodinasi kedalam pembuluh darah Ini berguna bagi menyoroti struktur sepertipembuluh darah yang jika tidak akan sukar untuk menggambarkan jaringan sekitarnyaPenggunaan material kontras dapat juga membantu ke arah memperoleh informasifungsional tentang jaringantisu

Gluecker T Capasso P Schnyder P Gudinchet F Schaller MD Revelly JP Chiolero R Vock P Wicky S 1999 Clinical and Radiologic Features of Pulmonary Edema Scientific Exhibit Volume 19 Number 6pp 1508-31

Smithuis R Delden OV Schaefer C 2007Lung-HRCT-Common Diseases Radiology Department of the Rijnland Hospital Leiderdorp and the Academical Medical Centre Amsterdam the Netherlands httpwwwradiologiassistantlung-hrct-common-diseaseshtml (diakses pada 10 april 2013)

Note edema can have a very unusual appearance and be distributed very patchy some areas are filled with fluid as opposed to other areas in immediate vicinity which appear normal

ldquoground glass appearancerdquo atau titik-titik halus di basis paru-paru dengan batas jantung dan diafragma yang tidak jelas

CT Scan digunakan di dalam kedokteran sebagai alat diagnostik dan sebagai pemanduuntuk prosedur intervensi Kadang-kadang membandingkan material seperti kontrasyang diodinasi kedalam pembuluh darah Ini berguna bagi menyoroti struktur sepertipembuluh darah yang jika tidak akan sukar untuk menggambarkan jaringan sekitarnyaPenggunaan material kontras dapat juga membantu ke arah memperoleh informasifungsional tentang jaringantisu

Gluecker T Capasso P Schnyder P Gudinchet F Schaller MD Revelly JP Chiolero R Vock P Wicky S 1999 Clinical and Radiologic Features of Pulmonary Edema Scientific Exhibit Volume 19 Number 6pp 1508-31

Smithuis R Delden OV Schaefer C 2007Lung-HRCT-Common Diseases Radiology Department of the Rijnland Hospital Leiderdorp and the Academical Medical Centre Amsterdam the Netherlands httpwwwradiologiassistantlung-hrct-common-diseaseshtml (diakses pada 10 april 2013)