Stase Semicluster Radiologi-Ilmu Penyakit Dalam RSUP.

Soeradji Tirtonegoro, Klaten

Nama : Ny. Tumini Usia : 75 tahun No. RM : 755218

KU : Sesak nafas dan batuk berdahak selama 1 bulan

RPS :

1BSMRS Os mengeluhkan batuk berdahak dan sesak nafas, memberat saat aktivitas (+), meringan dengan istirehat (-). Tidur menggunakan 2 bantal (-), bangun dimalam hari karena sesak (-). Sesak nafas saat dingin (-), terkena debu (-). Kedua tungkai bawah membengkak (-). Demam (-), pilek (-). Berobat ke puskesmas dan diberi obat (?) membaik. HMRS sesak nafas kambuh, os periksa ke UGD. Batuk (+), demam (-), pilek (-), perut terasa penuh (-), kaki bengkak (-). Memberat saat aktivitas (+), meringan dengan istirehat (-). Tidur menggunakan 2 bantal (-), bangun dimalam hari karena sesak (-). Sesak nafas saat dingin (-), terkena debu (-). BAB & BAK tak ada keluhan.

RPD Riwayat Riwayat Riwayat Riwayat

HT (-) DM (-) sakit ginjal (-) sakit jantung (-)

RPK Riwayat keluhan serupa dalam keluarga disangkal

KU

: lemah, compos mentis

Vital Sign TD : 115/70 mmHg N : 80x/mnt

R T

: 20x/mnt : 37,1 C

Kepala : CA (-/-), SI (-/-) Leher : JVP 5+2, lnn tidak teraba Dada-Paru I : KG (-), retraksi kosta (+) P : NT (-), pengembangan paru simetris, fremitus taktil ka=ki (meningkat di thorax dextra bawah) P : sonor (+), redup pada dada kanan bawah A: ves (+/+), RBK (+/+), RBB (+/+), wheezing (-/-)

Dada-jantung I : IC tampak pada SIC 5 Linea axillaris anterior P : IC teraba pada SIC 5 Linea axillaris anterior P : cardiomegali (-) A: Suara S1 (+) reguler, S2 (+) reguler, bising (-)

Abdomen I : Dinding dada sejajar dengan dinding paru A: BU (+) 7x/mnt P : timpani (+), hepatomegali (-), splenomegali (-), shifting dullness (-) P : NT (-), hepar & lien tidak teraba

Ekstremitas Edem -
-

WPK < 2 dtk Clubbing finger (-)

AL AE AT Hb MCV MCH MCHC BUN Crea AST ALT Ureum

17,9 3,68 280 11,6 89,9 29,9 33,2 19,6 1,54 65 31,2 41,9

Pneumonia TB PPOK Bronkitis Akut

Vc AA A AP

VAz

AaKi
AKa VKi

VKa

Chest p.a. and lateral :

The domes of the diaphragms are evenly shaped and positioned in proper height. The sinuses are not obliterated. The pleura shows no thickening. Both lung fields have the same transparency and no geographic or rounded densities. There is a harmonic bronchovascular branching right into the periphery of the lungs. The upper mediastinal shadow is not enlarged. The tracheal band is not narrowed. The hili are not enlarged. There is no pathologic transformation of the cardiac silhouette. The visualized parts of the skeleton are normal. The soft tissue of the chest wall is not conspicuous.

Chest p.a. and lateral :

The domes of the diaphragms are evenly shaped and positioned in proper height. The sinuses are not obliterated. The pleura shows no thickening. Both lung fields have the same transparency and no geographic or rounded densities. There is a harmonic bronchovascular branching right into the periphery of the lungs. The upper mediastinal shadow is not enlarged. The tracheal band is not narrowed. The hili are not enlarged. There is no pathologic transformation of the cardiac silhouette. The visualized parts of the skeleton are normal. The soft tissue of the chest wall is not conspicuous.

Chest radiograph revealing right upper lobe consolidation.

Sputum and blood cultures were positive for Streptococcus pneumoniae.

Right lung infiltrate (Pneumonia)

Right lung infiltrate (pneumonia) progression after 2 days

Posteroanterior chest radiograph demonstrates a bilateral, relatively symmetric distribution of hazy ground-glass opacities interspersed with areas of coalescing alveolar consolidation. A bilateral symmetric distribution of pulmonary opacities is typical of PCP (Pneumocystis carinii pneumonia). However, bacterial pneumonia can uncommonly mimic this appearance.

Bacterial pneumonia : Posteroanterior (A) and lateral (B) chest radiographs demonstrate focal consolidation in the right lower lobe, which was owing to a community-acquired bacterial pneumonia. The presence of focal consolidation is highly suggestive of bacterial pneumonia. Also note a small right-sided parapneumonic pleural effusion.

Lobar pneumonia : Posteroanterior chest radiographs demonstrate lobar pneumonia of the left lower lobe.

Lobar pneumonia

Bronchopneumonia

Bronchopneumonia of the right lung

The magnified view shows the irregular bronchovascular structures

Chest film and magnified view of right midfield. Irregular bronchovascular markings due to recurrent inflammation with scirrous deformation

Chest film and magnified view on the right. The lines that leave the right hilum horizontally show irregular borders because of chronic inflammation

Chest film and magnified view from right middle/upper lung field. Irregular contours of bronchovascular structures with irregular diameters

Pulmonary edema on supine view. Supine view is identified by the absence of fundal gas bubble below the diaphragm. Moreover, the scapulae are seen within the lung fields, which will not be there in a well positioned chest X-ray PA view. The apparent cardiomegaly cannot be commented upon since it is a supine.

When the cardiac size is normal, the possibilities to be thought of are acute left ventricular failure in acute myocardial infarction when the heart has not had enough time to get enlarged and in acute fulminant myocarditis

Lungs are large and hyperinflated. Signs of hyperinflation are low set diaphragm, increased AP diameter, vertical heart and increased retrosternal air. Signs of hyperinflation can be seen in emphysema, chronic bronchitis and asthma. We can call it emphysema only when hyperinflation is associated with blebs and paucity of vascular markings in the outer third of the film

Lungs are large and hyperinflated. Signs of hyperinflation are low set diaphragm, increased AP diameter, vertical heart and increased retrosternal air.
Signs of hyperinflation can be seen in emphysema, chronic bronchitis and asthma. We can call it emphysema only when hyperinflation is associated with blebs and paucity of vascular markings in the outer third of the film Lateral chest is best to evaluate flattening of diaphragm, AP diameter and retrosternal air

The presence emphysema can be suspected on routine chest radiography but this is not a sensitive technique for diagnosis. Large volume lungs with a narrow mediastinum and flat diaphragms are the typical appearances of emphysema. In addition, the presence of bullae and irregular distribution of the lung vasculature may be present. In more advanced disease, the presence of pulmonary hypertension may be suspected by the prominence of hilar vasculature.

The heart size is normal. The lungs are grossly hyperinflated with emphysematous changes particularly at the bases and parenchymal distortion consistent with COPD

Chest x-ray showing diffuse subcutaneous emphysema (black arrows) and a right-side pneumothorax (white arrows)

Ring shadow Terdapat bayangan seperti cincin dengan berbagai ukuran (dapat mencapai diameter 1 cm) dengan jumlah satu atau lebih bayangan cincin sehingga membentuk gambaran honeycomb appearance atau bounches of grapes. Bayangan cincin tersebut menunjukkan kelainan yang terjadi pada bronkus

Tampak Ring Shadow yang pada bagian bawah paru yang menandakan adanya dilatasi bonkus

Tampak dilatasi bronkus yang ditunjukkan oleh anak panah

Ring Shadow

Tramline shadow : Gambaran ini dapat terlihat pada bagian perifer paruparu. Bayangan ini terlihat terdiri atas dua garis paralel yang putih dan tebal yang dipisahkan oleh daerah berwarna hitam. Gambaran seperti ini sebenarnya normal ditemukan pada daerah parahilus. Tramline shadow yang sebenarnya terlihat lebih tebal dan bukan pada daerah parahilus

Frontal chest radiographs show diffuse cystic bronchiectasis (arrows) in both lungs

Severe cystically dilated bronchi most marked in the upper lung zones bilaterally due to cystic fibrosis

Coloured bronchogram of human lung showing bronchiectasis

Chest radiograph shows increase pulmonary markings bronchial wall thickening with dilatation, honey combing and cystic spaces

A large left sided pleural effusion as seen on an upright chest x-ray

Chest radiograph showing a right-sided transudative pleural effusion

Hemorrhagic effusion

Pleural effusion chest x-ray. The arrow A shows fluid layering in the right pleural cavity. The B arrow shows the normal width of the lung in the cavity

Pleural effusion more evident on lateral view

Chest x-ray showing bilateral air space disease, left pleural effusion, pneumomediastinum and subcutaneous emphysema