Radiologi - Pneumonia

7/29/2019 Radiologi - Pneumonia

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Stase Semicluster Radiologi-Ilmu Penyakit Dalam

RSUP. Soeradji Tirtonegoro, Klaten


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Nama : Ny. Tumini Usia : 75 tahun

No. RM : 755218


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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 karenasesak (-). Sesak nafas saat dingin (-), terkena debu (-). Keduatungkai 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 karenasesak (-). Sesak nafas saat dingin (-), terkena debu (-). BAB &BAK tak ada keluhan.


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RPD

Riwayat HT (-)

Riwayat DM (-)Riwayat sakit ginjal (-)

Riwayat sakit jantung (-)

RPK

Riwayat keluhan serupa dalam keluarga

disangkal


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KU : lemah, compos mentis

Vital Sign

TD : 115/70 mmHg R : 20x/mnt

N : 80x/mnt T : 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 (-/-)


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Dada-jantungI : IC tampak pada SIC 5 Linea axillaris anteriorP : IC teraba pada SIC 5 Linea axillaris anteriorP : cardiomegali (-)A: Suara S1 (+) reguler, S2 (+) reguler, bising (-)

AbdomenI : Dinding dada sejajar dengan dinding paruA: BU (+) 7x/mntP : timpani (+), hepatomegali (-), splenomegali (-), shifting

dullness (-)P : NT (-), hepar & lien tidak teraba


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EkstremitasEdem

WPK < 2 dtkClubbing finger (-)

- -- -


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AL 17,9

AE 3,68

AT 280

Hb 11,6

MCV 89,9

MCH 29,9 MCHC 33,2

BUN 19,6

Crea 1,54

AST 65

ALT 31,2

Ureum 41,9


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Pneumonia TB

PPOK

Bronkitis Akut


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AA

AP

AaKi

VKi

Vc

A

VAz

AKa

VKa


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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 bronchovascularbranching 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 transformationof the cardiac silhouette.

The visualized parts of the skeleton are

normal.

The soft tissue of the chest wall is not

conspicuous.


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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 bronchovascularbranching 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 transformationof the cardiac silhouette.

The visualized parts of the skeleton are

normal.

The soft tissue of the chest wall is not

conspicuous.


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Chest radiograph revealingright upper lobeconsolidation.Sputum and blood cultures were positive for

Streptococcus pneumoniae.


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Right lung infiltrate (Pneumonia) Right lung infiltrate (pneumonia)progression after 2 days


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Posteroanterior chestradiograph demonstrates abilateral, relativelysymmetric distribution ofhazy ground-glass opacitiesinterspersed with areas of

coalescing alveolarconsolidation. A bilateralsymmetric distribution ofpulmonary opacities istypical of PCP (Pneumocystiscarinii pneumonia). However,

bacterial pneumonia canuncommonly mimic thisappearance.


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Bacterial pneumonia : Posteroanterior (A) and lateral (B) chestradiographs demonstrate focal consolidation in the right lower lobe,which was owing to a community-acquired bacterial pneumonia. Thepresence of focal consolidation is highly suggestive of bacterialpneumonia. Also note a small right-sided parapneumonic pleuraleffusion.


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Lobar pneumonia :Posteroanteriorchest radiographsdemonstrate lobarpneumonia of theleft lower lobe.


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Lobarpneumonia


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Bronchopneumonia


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Bronchopneumonia of the right lung


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The magnified view shows the irregular bronchovascular structures


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Chest film and magnified view of right midfield. Irregularbronchovascular markings due to recurrent inflammation withscirrous deformation


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


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

diameters


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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.


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When the cardiac size is normal, the possibilities to be thought of are acuteleft ventricular failure in acute myocardial infarction when the heart has not

had enough time to get enlarged and in acute fulminant myocarditis


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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


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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 isassociated with blebs and paucity of vascular

markings in the outer third of the film

Lateral chest is best to evaluate flattening ofdiaphragm, AP diameter and retrosternal air


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The presence emphysema

can be suspected on routine

chest radiography but this isnot a sensitive technique for

diagnosis. Large volume lungs

with a narrow mediastinum

and flat diaphragms are the

typical appearances of

emphysema. In addition, thepresence of bullae and

irregular distribution of the

lung vasculature may be

present. In more advanced

disease, the presence of

pulmonary hypertension maybe suspected by the

prominence of hilar

vasculature.


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The heart size is

normal. The lungs

are grosslyhyperinflated with

emphysematous

changes particularly

at the bases and

parenchymal

distortion consistentwith COPD


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Chest x-ray showing diffuse subcutaneous emphysema (black arrows) and a

right-side pneumothorax (white arrows)


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Ring shadow

Terdapat bayangan seperti

cincin dengan berbagai

ukuran (dapat mencapai

diameter 1 cm) dengan jumlah

satu atau lebih bayangancincin sehingga membentuk

gambaran honeycomb

appearance atau bounches

of grapes. Bayangan cincin

tersebut menunjukkan

kelainan yang terjadi pada

bronkus


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Tampak dilatasi bronkus yang

ditunjukkan oleh anak panah

Tampak Ring Shadow yang pada

bagian bawah paru yang

menandakan adanya dilatasi bonkus


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Ring Shadow


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Tramline shadow :Gambaran ini dapat terlihat

pada bagian perifer paru-

paru. Bayangan ini terlihat

terdiri atas dua garis

paralel yang putih dan

tebal yang dipisahkan olehdaerah berwarna hitam.

Gambaran seperti ini

sebenarnya normal

ditemukan pada daerah

parahilus. Tramline shadow

yang sebenarnya terlihatlebih tebal dan bukan pada

daerah parahilus


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Frontal chest radiographsshow diffuse cystic

bronchiectasis (arrows) in

both lungs


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Severe cystically

dilated bronchi

most marked in the

upper lung zones

bilaterally due to

cystic fibrosis


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Coloured

bronchogram of

human lung

showing

bronchiectasis


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Chest

radiograph

shows

increase

pulmonarymarkings

bronchial wall

thickening with

dilatation,

honey combing

and cystic

spaces


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A large left sided pleural

effusion as seen on an upright

chest x-ray


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Chest radiograph showing a right-sided transudative

pleural effusion


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Hemorrhagic effusion


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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


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Pleural effusion more evident on lateral view


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Chest x-ray showing bilateral air space disease, left pleural effusion,

pneumomediastinum and subcutaneous emphysema

Radiologi - Pneumonia

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