Pemeriksaan Radiologi Pada Sistem Respirasi01.ppt

8/17/2019 Pemeriksaan Radiologi Pada Sistem Respirasi01.ppt

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Chest X-rayChest X-ray

InterpretationInterpretation

Dr. Herman Pieter Louis Wungouw, Sp.Rad

Departemen Radiologi FK Undana


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IntroductionIntroduction

Routinely obtained

Pulmonary specialist consultation

n!erent p!ysical e"am limitations

#!est "$ray limitations

P!ysical e"am and c!est "$ray pro%idecompliment


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Essentials Before GettingEssentials Before Getting

StartedStartedPat! o) "$ray beam

' P+

' +PPatient Position

' Uprig!t

' Supine


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Essentials Before GettingEssentials Before Getting

StartedStartedreat!

' nspiration

' &"piration


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Systematic ApproachSystematic Approach

ony Framewor-

So)t issues

Lung Fields and Hila

Diap!ragm and Pleural Spaces

*ediastinum and Heart+bdomen and /ec-


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ony Fragments

' Ribs

' Sternum ' Spine

' S!oulder girdle

' #la%icles


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So)t issues

' reast s!adows

' Supracla%icular areas ' +"illae

' issues along side o)

breasts


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Lung Fields and Hila ' Hilum

Pulmonary arteries Pulmonary %eins

' Lungs Linear and )ine nodular

s!adows o) pulmonary

%essels ' lood %essels

' 012 obscured by ot!ertissue


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Diap!ragm and

Pleural Sur)aces

' Diap!ragm Dome$s!aped

#ostop!renic angles

' /ormal pleural is not

%isible ' nterlobar )issures


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*ediastinum and

Heart

' Heart si3e on P+ ' Rig!t side

n)erior %ena ca%a

Rig!t atrium

+scending aorta Superior %ena ca%a


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*ediastinum and

Heart

' Le)t side Le)t %entricle

Le)t atrium

Pulmonary artery

+ortic arc!

Subcla%ian artery and

%ein


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+bdomen and /ec-

' +bdomen

4astric bubble +ir under diap!ragm

' /ec- So)t tissue mass

+ir bronc!ogram


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Summary of DensitySummary of Density

+ir

Water

oneissue

issue


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Pitfalls to Chest X-rayPitfalls to Chest X-ray

InterpretationInterpretationPoor inspiration

(%er or under penetration

Rotation

Forgetting t!e pat! o) t!e "$ray beam


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Lung AnatomyLung Anatomy

rac!ea

#arina

Rig!t and Le)t Pulmonaryronc!i

Secondary ronc!i

ertiary ronc!i

ronc!ioles +l%eolar Duct

+l%eoli


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Lung AnatomyLung Anatomy

Rig!t Lung

' Superior lobe

' *iddle lobe ' n)erior lobe

Le)t Lung

' Superior lobe

' n)erior lobe


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Lung Anatomy on Chest X-rayLung Anatomy on Chest X-ray

P+ 5iew6

' &"tensi%e o%erlap

' Lower lobes e"tend!ig!

Lateral 5iew6

' &"tent o) lower lobes


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!e rig!t upper lobe

7RUL8 occupies t!e upper

9:; o) t!e rig!t lung.

Posteriorly, t!e RUL is

ad


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!e rig!t middle lobe

is typically t!e

smallest o) t!e t!ree,and appears triangular

in s!ape, being

narrowest near t!e

!ilum


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!e rig!t lower lobe is t!elargest o) all t!ree lobes,separated )rom t!e ot!ers by

t!e ma


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!ese lobes can be separated)rom one anot!er by two)issures.

!e minor )issure separates t!eRUL )rom t!e R*L, and t!usrepresents t!e %isceral pleuralsur)aces o) bot! o) t!ese lobes.

(riented obli>uely, t!e ma


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!e lobar arc!itecture

o) t!e le)t lung is

slig!tly di))erent t!ant!e rig!t.

ecause t!ere is no

de)ined le)t minor

)issure, t!ere are onlytwo lobes on t!e le)t?

t!e le)t upper


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Le)t lower lobes


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!ese two lobes areseparated by a ma


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he !ormal Chest X-rayhe !ormal Chest X-ray

P+ 5iew6

9. +ortic arc!

@. Pulmonary trun-

;. Le)t atrial appendage

0. Le)t %entricle

A. Rig!t %entricle

=. Superior %ena ca%a

B. Rig!t !emidiap!ragm

C. Le)t !emidiap!ragm

. Hori3ontal )issure


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he !ormal Chest X-rayhe !ormal Chest X-ray

Lateral 5iew6

9. (bli>ue )issure

@. Hori3ontal )issure;. !oracic spine and

retrocardiac space

0. Retrosternal space


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"nderstanding Pathological"nderstanding Pathological

ChangesChanges*ost disease states replace air wit! a

pat!ological process

&ac! tissue reacts to in


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Li#uid DensityLi#uid Density

Liquid density Increased air density

Generalized Localized

Di))use al%eolar

Di))use interstitial*i"ed

5ascular

n)iltrate

#onsolidation#a%itation

*ass

#ongestion

+telectasis

Locali3ed airway obstruction

Di))use airway obstruction&mp!ysema

ulla


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ConsolidationConsolidation

Lobar consolidation6 ' +l%eolar space )illed wit!

in)lammatory e"udate

' nterstitium andarc!itecture remain intact

' !e airway is patent

' Radiologically6 + density corresponding to

a segment or lobe +irbronc!ogram, and /o signi)icant loss o) lung

%olume


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Atelectasis Atelectasis

Loss o) air

(bstructi%e atelectasis6

' /o %entilation to t!e lobe beyond obstruction

' Radiologically6 Density corresponding to a

segment or lobe

Signi)icant loss o) %olume #ompensatory

!yperin)lation o) normallungs


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Stages of E$aluating anStages of E$aluating an

A%normality A%normality9. denti)ication o) abnormal s!adows

@. Locali3ation o) lesion

;. denti)ication o) pat!ological process0. denti)ication o) etiology

A. #on)irmation o) clinical suspension

#omple" problems ntroduction o) contrast medium

# c!est

*R scan


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Case &Case &


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+ single, ;cm relati%ely t!in$walled ca%ity is noted in t!e le)t

midlung. !is )inding is most typical o) s>uamous cell carcinoma

7S##8. (ne$t!ird o) S## masses s!ow ca%itation


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Case 'Case '


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LUL +telectasis6 Loss o) !eart borders:sil!ouetting. /otice

o%er in)lation on una))ected lung


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Case (Case (


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Rig!t *iddle and Le)t Upper Lobe Pneumonia


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Case )Case )


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#a%itation6cystic c!anges in t!e area o) consolidation due to t!e

bacterial destruction o) lung tissue. /otice air )luid le%el.


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#a%itation


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Case *Case *


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uberculosis


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Case +Case +


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#(PD6 increase in !eart diameter, )lattening o) t!e diap!ragm, and

increase in t!e si3e o) t!e retrosternal air space. n addition t!e

upper lobes will become !yperlucent due to destruction o) t!e lung

tissue.


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Case ,Case ,


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Pseudotumor6 )luid !as )illed t!e minor )issure creating a density t!at

resembles a tumor 7arrow8. Recall t!at )luid and so)t tissue are

indistinguis!able on plain )ilm. Furt!er analysis, !owe%er, re%eals a

classic pleural e))usion in t!e rig!t pleura. /ote t!e rig!t lateral gutter

is blunted and t!e rig!t diap!ram is obscurred.


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Case Case


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Pneumonia6a large pneumonia consolidation in t!e rig!t lower

lobe. Knowledge o) lobar and segmental anatomy is important in

identi)ying t!e location o) t!e in)ection


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Case .Case .


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#HF6a great deal o) accentuated interstitial mar-ings,

#urly lines, and an enlarged !eart. /ormally indistinct

upper lobe %essels are prominent but are also mas-ed

by interstitial edema.


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Case &/Case &/


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#!est wall lesion6 arising o)) t!e c!est wall and not t!e lung


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Pleural e))usion6 /ote loss o) le)t !emidiap!ragm. Fluid drained

%ia t!oracentesis


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Case &'Case &'


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Lung *ass


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Case &(Case &(


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Small Pneumot!ora"6 LUL


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Case &*Case &*


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Rig!t *iddle Lobe Pneumot!ora"6 complete lobar collapse


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Post c!est tube insertion and re$e"pansion


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Case &+Case &+


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*etastatic Lung #ancer6 multiple nodules seen


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Case &,Case &,


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Rig!t upper lower lobe pulmonary nodule


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Case &Case &


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uberculosis


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Case &.Case &.


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Case '/Case '/


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Widened *ediastinum6 +ortic Dissection


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Case '&Case '&


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Pulmonary artery stenosis wit! cardiomegally li-ely

secondary to stenosis.


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0uestions10uestions1


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TEKNIK PEMERIKSAAN FOTO THORA


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&4+/4+/ 7B1$9@18 K5

+RUS 79= $@1 8 *+S

FFD 9,A *

S4A2A-S4A2AS4A2A-S4A2A


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/SPR+S #UKUP #(S+ 5 D&P+/ K+/+/

*&*((/4 P&R&/4+H+/ H&*D+PHR+4*+

K+/+/

Simitris

G Leta- diap!ragma -anan !arus minimal setinggi S#

bela-ang

Kondisi )oto !arus bai- 6 corpus %ertebrae t!oracal yang bole!

terli!at ma"imal 5 t! 0$A .

Seluru! lapangan paru !arus terco%er

ida- ada arte)act atau corpus alienum 7 barang@ 8 U+/4

L(4+*, R+*U DLL

633 4A!G BAI5633 4A!G BAI5


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Kondisi pasien tida-

memung-in-an P+

*eli!at collumna %ertebralis

ida- bisa mengu-ur


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Untu- meli!at proses:lesi di ape"

Posisi +P , pasien bersandar miring pada

-aset )ilm , sinar dari ara! depan

6oto top Lordotic6oto top Lordotic


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*endete-si adanya pneumot!ora"

dengan manu%er inspirasi dan e-spirasi

6oto Inspirasi7E8pirasi6oto Inspirasi7E8pirasi


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*endete-si adanya pleural e))usi

Pasien bila mung-in miring dulu I:$ 9A menit

Film 7 -aset 8 ditaru! di mu-a , sinar dari bela-ang.

Left72ight Lateral Decu%itusLeft72ight Lateral Decu%itus


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Pemeriksaan Radiologi Pada Sistem Respirasi01.ppt

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