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PRESENTASI

RADIOLOGI
PULMONARY EDEMA
 Akumulasi cairan berlebih
pada paru
› Interstitial
› Alveolar

 Normal: sangat sedikit cairan


› Drainage lymphatic
› Keseimbangan tekanan

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 Faktor yang mempengaruhi pergerakan cairan
kapiler dan interstitium
› Hidrostatik
› Onkotik
› Permeabilitas kapiler

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 Peningkatan Tekanan Hidrostatik
› Kardiogenik (Left Sided Heart Failure, Severe Systemic Hypertension,
Hipertensi Vena Pulmonal)
› Non kardiogenik (Gagal ginjal, IV fluid over)
 Berkurangnya Tekanan Osmotik
› Hypoalbumin (Malnutrisi, Liver failure)
› Nephrotic syndrome

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 Peningkatan Permeabilitas
› Endothelial injury
› Allergic Reaction

 Obstruksi sistem limfatik


› Penekanan yang terjadi karena edema, tumor, jaringan fibrotik

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* PCWP
Pulmonary capillary wedge pressure -
perkiraan tekanan atrium kiri
Upper zone vessel enlargement

Normal CHF
Upper zone vessel enlargement
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Fluid leakage into the interlobular and peribronchial interstitium
Kerley B or septal lines : fluid leaks into the peripheral interlobular septa
Kerley B or septal lines : fluid leaks into the peripheral interlobular septa
Terlihat pada basal paru dan tegak lurus dengan permukaan pleura
Kerley B or septal lines : fluid leaks into the peripheral interlobular septa
Terlihat pada basal paru dan tegak lurus dengan permukaan pleura
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Fluid leakage into the interlobular and peribronchial interstitium
peribronchial cuffing: thickening of the bronchial walls
perihilar haze: loss of definition of these vessels
perihilar haze: loss of definition of pulmonary vessels because they
are surrounded by edema.

perihilar haze
peribronchial cuffing: thickening of the bronchial walls
small doughnut-shaped rings
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Leakage into the interstitium cannot be compensated by lymphatic.
This eventually leads to fluid leakage in the alveoli (alveolar edema) and
to leakage into the pleural space (pleural effusion).

Airspace (alveolar) disease = air bronchograms.


The visibility of air in the bronchus
caused by fluid filling the alveoli and small airways

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acute setting this airspace shadowing radiates from the hilar regions in a
'bat's wing' distribution and then becomes more generalised

bat-wing or angel-wing configuration

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acute setting this airspace shadowing radiates from the hilar regions in a
'bat's wing' distribution and then becomes more generalised

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acute setting this airspace shadowing radiates from the hilar regions in a
'bat's wing' distribution and then becomes more generalised

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The causes of noncardiogenic pulmonary edema:
• Increased capillary permeability.
• Sepsis, Uremia, DIC, Smoke inhalation, near-drowing
• Volume overload
• Lymphangitic spread of malignancy
• High-altitude pulmonary edema
• Neurogenic pulmonary edema
• Reexpansion pulmonary edema
• Heroin or other overdose

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