Laporan Pagi

NURAIN AMIRAH
14833
Identitas Pasien

Nama : Ny D
Usia : 74tahun
Jenis Kel : Perempuan
No RM : 0174 *****
Klinis :Adenocarcinoma of the lung
Uraian Hasil Pemeriksaan
Foto thorax, proyeksi AP, posisi
supine, asimetris, inspirasi dan
kondisi cukup, hasil:
Tampak corak bronkovasular pulmo
sinistra normal.
Tampak opasitas inhomogen pada
aspek laterobasal hemithorax
dextra yang menutupi
hemidiafragma dextra, sudut
costrophrenicus dextra dan atas
jantung dextra serta melebarkan
pleural space dextra.
Tampak opasitas homogeny pada
aspek basal hemithorax dextra yang
menutupi seluruh lapang paru
dextra , batas tak tegas.
Uraian Hasil Pemeriksaan
Foto thorax, proyeksi AP, posisi
supine, asimetris, inspirasi dan
kondisi cukup, hasil:
Tak tampak pelebaran pleural space
sinistra
Hemidiafragma sinistra licin dan tak
mendatar
Cor, CTR tak valid dievaluasi
Sistema tulang intak, tak tampak
lesi sklerotik
Kesan
Foto thorax, proyeksi AP, posisi
supine, asimetris, inspirasi dan
kondisi cukup, hasil:

Massa pulmo dextra disertai efusi

pleura dextra
Besar cor tak valid dinilai
Tak tampak skeletal metastasis pada
Sistema tulang yang tervisualisasi
Pleural effusion
DEFINITION

Pleural effusion tends to be used as a catch-all term denoting a

collection of fluid within the pleural space. This can be further
divided into exudates and transudates depending on the biochemical
analysis of aspirated pleural fluid. Essentially it represents any
pathological process which overwhelms the pleura's ability to
reabsorb fluid.
Type
1. Transudates
Transudative effusions are caused by some combination of
increased hydrostatic pressure and decreased plasma oncotic
pressure. Heart failure is the most common cause, followed by
cirrhosis with ascites and by hypoalbuminemia, usually due to
the nephrotic syndrome.

2. Exudative.
Exudative effusions are caused by local processes leading to
increased capillary permeability resulting in exudation of fluid,
protein, cells, and other serum constituents.
PLEURAL EFFUSION RADIOLOGIC FINDINGS

Plain radiograph
Chest radiographs are the most commonly used examination to
assess for the presence of a pleural effusion; however, it should be
noted that on a routine erect chest x-ray as much as 250-600 ml of
fluid is required before it becomes evident . A lateral decubitus film is
most sensitive, able to identify even a small amount of fluid. At the
other extreme, supine films can mask large quantities of fluid.
Lateral decubitus (most sensitive)
Chest radiograph (erect)
Both PA and AP erect films are insensitive to small amounts of fluid.
Features include:
blunting of the costophrenic angle
blunting of the cardiophrenic angle
fluid within the horizontal or oblique fissures
eventually, a meniscus will be seen (upward U shape), on frontal films
seen laterally and gently sloping medially (note: if a
hydropneumothorax is present, no such meniscus will be visible)
with large volume effusions, mediastinal shift occurs away from the
effusion (note: if coexistent collapse dominates then mediastinal shift
may occur towards the effusion)
 Lateral film
Lateral films are able to identify a smaller amount of fluid as the
costophrenic angles are deepest posteriorly.
A subpulmonic effusion (aka infrapulmonary effusion) may be seen
when there is previously established pulmonary disease, but can also
be encountered in normal lungs. It can be difficult to identify on frontal
radiographs. They are more common on the right, and usually
unilateral. The following features are helpful :
right: peak of the hemidiaphragm is shifted laterally
left: increased distance between lower lobe air and gastric air bubble
Erect and lateral film

Meniscus sign : u shape

Blunting of costophrenic angle

Blunting of costophrenic angle posteriorly
Treatment and prognosis

The treatment of pleural effusions is usually targeted to the underlying

condition (e.g. congestive cardiac failure or malignancy). In some
instances patients are symptomatic from large effusions (especially if
they have an underlying cardiovascular disease) and therapeutic
aspiration (thoracentesis) can be carried out.
Referensi

https://radiopaedia.org/articles/pleural-effusion
http://www.msdmanuals.com/professional/pulmonary-
disorders/mediastinal-and-pleural-disorders/pleural-effusion
Kumar, V., & Robbins, S. L. 1. (2007). Robbins basic pathology (8th
ed.). Philadelphia, PA: Saunders/Elsevier.