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JURNAL READING

Chest X-ray Lung Disease


Nathania Christika
406147045

CONSOLIDATION

1. Lobar consolidation
2. Diffuse consolidation
3. Multifocal ill-defined consolidations

Characteristics of Consolidation
Produces opacities in the lung that can be
described as fluffy, cloudlike, and hazy.
The opacities tend to be confluent, merging into
one another.
The margins of airspace disease are fuzzy and
indistinct.
Air bronchograms or the silhouette sign may be
present.

Shillouete Sign
Solid black arrow :
hilangnya bayangan
batas kanan jantung
Dotted black arrow :
bayangan
hemidiafragma kanan
tidak hilang

Key sign to recognizing Pneumonia


More opaque than surrounding normal lung.
In airspace disease, the margins may be fluffy and indistinct
except where they abut a pleural surface like the interlobar
fissures where the margin will be sharp.
Interstitial pneumonias will cause a prominence of the
interstitial tissues of the lung in the affected area; in some
cases, the disease can spread to the alveoli and resemble
airspace disease.
Pneumonia tends to be homogeneous in density.
Lobar pneumonias may contain air bronchograms.
Segmental pneumonias may be associated with atelectasis in
the affected portion of the lung.

Right upper lobe


pneumococcal
pneumonia
Dotted white arrow : air
bronchograms

Solid white arrow : The


inferior margin of the
pneumonia is more sharply
demarcated because it is in
contact with the minor
fissure

Lobar Pneumonia

Diagnosis
Pneumonia - consolidation with pus

Differential diagnosis of consolidation


Pneumonia - airways full of pus
Cancer - airways full of cells
Pulmonary haemorrhage - airways full of blood
Pulmonary oedema - airways full of fluid

Bronchopneumonia

Multiple irregularly marginated patches of airspace disease are present in both lungs (solid white
arrows).
The disease is spread centrifugally via the tracheobronchial tree to many foci in the lung at the same
time so it frequently involves several segments. Because lung segments are not bound by fissures, the
margins of segmental pneumonias tend to be fluffy and indistinct. No air bronchograms are present
because inflammatory exudate fills the bronchi as well as the airspaces around them.

Acute pulmonary
alveolar edema
Solid white arrows : Fluffy,
bilateral, perihilar airspace
disease with indistinct
margins, sometimes
described as having a batwing or angel-wing.
No air bronchograms are
seen.
The heart is enlarged.
This represents pulmonary
alveolar edema secondary
to congestive heart failure.

BATWING :
Konsolidasi bilateral pada perihilar
Khas pada Edem Pulmo

REVERSED BATWING :
Konsolidasi perifer/subpleura
Ditemukan pada penyakit paru kronis

Batwing & Reverse Batwing

INTERSTITIAL DISEASE
1. Reticular

2. Nodular
2. Reticonodular

The patterns of interstitial lung disease

Reticular

Nodular

Reticulonodular,
have a mixture of
both a reticular (lines)
and nodular (dots)
pattern

Characteristics of Interstitial Lung Disease


Interstitial disease has discrete reticular, nodular, or
reticulonodular patterns.
Packets of disease are separated by normalappearing, aerated lung.
Margins of packets of interstitial disease are
usually sharp and discrete.
Disease may be focal or diffusely distributed in the
lungs.
Usually no air bronchograms are present.

1. RETICULAR :

Pulmonary interstitial edema secondary to


congestive heart failure
Black circle : A close-up view of the
right lung shows an accentuation of the
pulmonary interstitial markings.
White circle : Multiple Kerley B lines
represent fluid in thickened
interlobular septa.
Solid black arrow : Fluid is seen in the
inferior accessory fissure.

Kerley B lines are 1-2 cm long horizontal lines near the lateral pleura.
The main differential diagnosis of Kerley B lines is :
Interstitial edema in heart failure
lymphangitis carcinomatosa

2. NODULAR :

Adenocarcinoma
Solid white arrow : A mass is
seen in the right upper lobe.
Solid black arrow : Its margin is
slightly indistinct along the
superolateral border.

Metastases to the lung


A : Multiple discrete nodules of varying size are
present throughout both lungs (solid white
arrows).
B : The interstitial markings in the right lung are
prominent (solid white arrow), there are septal
lines (dotted black arrow) and
lymphadenopathy (solid black arrows) from
lymphangitic spread of a bronchogenic
carcinoma.
C : In this case, the lung cancer has grown
through the chest wall (solid white arrow) and
invaded it by direct extension.

3. RETICULONODULAR :
Sarcoidosis

Sarcoidosis
Solid black arrow : Bilateral
hilar.
Dotted black arrow : Right
paratracheal adenopathy.
Blcak circle : In addition, the
patient has diffuse, bilateral
interstitial lung disease.

Membedakan konsolidasi dengan


insterstitial
Always look at the peripheral
margins of parenchymal lung
disease to best determine
the nature of the packets
of abnormality and to help in
differentiating airspace
disease from interstitial
disease.
Solid black arrow : Notice
how a portion of this disease
appears confluent, like
airspace disease.
Black circle : At the
periphery of this disease,
this is more clearly seen to
be reticular interstitial
disease.

ATELECTASIS
1.
2.

Lobar atelectasis
Total atelectasis

Atelectasis or lung-collapse is the result of loss of air in a


lung or part of the lung with subsequent volume loss due to
airway obstruction or compression of the lung by pleural
fluid or a pneumothorax.

1. Lobar Atelectasis

The most common causes of atelectasis are:


Bronchial carcinoma in smokers
Mucus plug in patients on mechanical ventilation
or astmathics (ABPA)
Malpositioned endotracheal tube
Foreign body in children

a) Right upper lobe atelectasis

b) Right middle lobe atelectasis

The findings are :


Blurring of the right heart border (silhouette sign)
Triangular density on the lateral view as a result of
collapse of the middle lobe

c) Right lower lobe atelectasis

Lower lobe atelectasis.

Follow up

Notice the abnormal right border of the heart.


The right interlobar artery is not visible, because it is not surrounded by aerated lung but by the collapsed
lower lobe.
Notice the reappearance of the right interlobar artery (red arrow) and the normal right heart border
(blue arrow).

d) Left upper lobe atelectasis

Minimal volume loss with elevation of the left


diaphragm
Abnormal left hilus, i.e. possible obstructing mass

e) Left lower lobe atelectasis

There is a triangular density seen through the cardiac shadow.


This is confirmed on the lateral view.
We cannot see the lower lobe vessels, because they are surrounded by the atelectatic lobe.
Normally when you follow the thoracic spine form top to bottom, the lower region becomes less opaque.
(blue arrow).

2. Total atelectasis

The entire right hemithorax is opacified. The trachea has shifted toward the right (solid black
arrow), and the heart is displaced toward the right as well (solid white arrow). Both of these
mobile structures have moved toward the side of opacification.

1. Seorang anak perempuan datang dengan keluhan batuk


berdahak sudah 1 minggu, disertai dengan sesak nafas.
Pemeriksaan radiologi apa yang anda usulkan?
2. Dari hasil pemeriksaan tersebut, didapatkan hasil :

Apakah kelainan yang ditemukan pada foto tersebut?

3. Seorang laki-laki datang dengan sesak nafas sejak 2 jam


yang lalu. Dada terasa tertekan, ekstermitas bengkak.
Pada pemeriksaan TD 150/100mmHg. Dari hasil
pemeriksaan tersebut, didapatkan hasil :

Apakah kelainan yang tampak pada foto tersebut?

4. Seorang laki-laki datang dengan sesak nafas. Pada


pemeriksaan fisik, stem fremitus kanan dan kiri tidak
sama kuat. Dilakukan pemeriksaan radiologi dan
didapatkan hasil :

Apakah kelainan yang tampak pada foto tersebut?

5. Bagaimana terbentuknya konsolidasi?


6. Apakah yang dimaksud Silhouette sign?
7. Pasien laki-laki datang dengan keluhan batuk berdarah
sudah 3 minggu. Pasien juga mengeluh dadanya sesak dan
badannya lemas. Setelah dilakukan pemeriksaan radiologi,
didapatkan hasil :

Apakah kelainan yang tampak pada foto tersebut?

8. Bagaimana cara menegakkan diagnosis pada foto


tersebut?
9. Seorang laki-laki usia 60 tahun datang dengan keluhan
batuk sejak 2 minggu yang lalu. Pasien memiliki riwayat
merokok sejak usia 20 tahun. Hasil pemeriksaan radiologi
didapatkan :

Apakah kelainan yang tampak pada foto tersebut?

10. Karena tidak mendapatkan pengobatan yang tepat,


akhirnya pasien datang kembali dengan kondisi sakit
berat, sesak nafas, dan badan lemas. Pemeriksaan
radiologi didapatkan hasil :

Apakah kelainan yang tampak pada foto tersebut?

1.
2.
3.
4.

Foto x-ray thorax


Konsolidasi pada lobus media paru kanan.
Konsolidasi bilateral (diffuse).
Efusi pleura kanan. Sudut costophrenicus tumpul,
diafragma datar.
5. Konsolidasi terbentuk akibat tergantinya isi alveolus
dengan pus/air/darah/sel.
6. Silhouette sign adalah hilangnya bayangan organ yang
normal.
7. Reticulonodular.
8. Melihat bagian perifer.
9. SPN
10. Atelektasis paru kanan dengan efusi pleura kanan