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Sumarsono
Lateral decubitus position:
It is helpful to assess the volume of pleural
effusion and demonstrate whether a pleural
effusion is mobile or loculated.
1. FULL INSPIRASI
2. TIDAK ADA TUMPANG TINDIH
3. SIMETRIS
4. KONDISI FOTO BAIK
5. REPRESENTATIF
Thorax Normal
Chest breast implants
Quality Control
Penetration
Should be able to 4
7
Heart shadow should
not be hidden by the 8
diaphragm 9
10
Poor inspiration
can crowd lung
markings
producing pseudo-
8
airspace disease
7. Rotation
Medial ends of
bilateral clavicles are
equidistant from the
midline or vertebral
bodies
If spinous process appears closer to the right clavicle (red arrow), the
patient is rotated toward their own left side
PENTING .!!!!!
MEMBACA FOTO THORAX
HARUS DISERTAI INFORMASI
KLINIS
Viewing PA radiograph of the chest
Ribs
PENGETAHUAN DASAR MEMBACA
KASUS KARDIOVASCULAR PADA
FOTO THORAX
Mampu mengenal / Membaca
Pembacaan dasar
Silhouette sign
Air bronchogram sign (ABS)
CTR / Sisi Pembesaran Jantung
Corakan Vascular
Diafragma
Efusi Pleura
Garis Kirley
Pola pola khusus (elemeyer glass, sepatu
boot, butterfly dan bat wing)
Aorta yang menonjol / prominen
(ielongatio aorta) juga sering
ditemukan kalsifikasi aorta. biasanya
pada pasien hipertensi kronik
Conus pulmonalis merupakan gambaran
dari main arteri pulmonal yang jika
menonjol bisa jadi terdapat hipertensi
arteri pulmonal seperti pada pasien mitral
stenosis, Atrial Septal Defect (ASD) dan
Primary Pulmonal Hypertension (PPH).
0 mm 15 mm
Ao
Ao
Main
Pulmonary
Artery
Main
Pulmonary
Artery
LV
LV
Main pulmonary
artery ranges from
0 mm15mm
from tangent line
SILHOUETTE SIGN
Silhouette Sign
Upper left
Right heart border heart border
(medial RML) (anterior
LUL)
Left heart
border
Anterior (lingula;
hemidiaphragms anterior)
(anterior
lower lobes)
SILHOUETTE SIGN
Air Bronchogram Sign (ABS)
Terlihat pada :
Lung consolidation
Pulmonary edema
Non-obstructive pulmonary atelectasis
Interstitial disease
Neoplasm
Normal expiration
AIR BRONCHOGRAM
AIR BRONCHOGRAM
AIR BRONCHOGRAM
CORAKAN BRONKHOVASKULER
CARA PENILAIAN
BAGI PARU DARI TEPI MENJADI 3, LIHAT BAGIAN 1/3 LATERAL
NORMAL :
Kanan: </= 2/3 medial paru (tarik 2 garis khayal vertikal
yang membagi paru menjadi 3) (1/3 LATERAL
TAMPAK BERSIH)
INTERPRETASI:
NORMAL /MENINGKAT
CORAKAN BRONKHOVASKULER
NORMAL
Normal Distribution of Flow
Upper Versus Lower Lobes
In erect position,
blood flow to
bases > than flow
to apices
Size of
vessels at
bases is
normally
> than size
of vessels
at apex You cant measure size of
vessels at the left base
because the heart obscures
them
Right Descending Pulmonary Artery
Right
Descending
Pulmonary
Artery
Serves right
middle and
lower lobes
1. Right Descending Pulmonary Artery
Diameter can
be measured
(before
bifurcation)
RDPA 2
< 17 mm in
diameter Gradual
tapering of
1 vessels
from central
to
peripheral
3
Lower lobe
vessels
larger than
2 upper lobe
vessels
Venous Hypertension
RDPA usually
> 17 mm
Upper lobe
vessels equal
to or larger
than size of
lower lobe
vessels =
Cephalization
Pulmonary Arterial Hypertension
Main
Pulmonary
Artery
RDPA usually projects
> 17 mm beyond
tangent line
Increased Flow
RDPA usually
> 17 mm
Distribution of
flow is
maintained as
in normal
Gradual
tapering from
central to
peripheral
Lower lobe
vessels bigger
than upper
lobe
Normal Increased Flow
Decreased Flow
Unrecognizable
most of the
time
Small hila
Fewer than
normal blood
vessels
SINUS COSTOPHRENICUS
INTERPRETASI
LANCIP ATAU TUMPUL
NORMAL : LANCIP
BILA TUMPUL PASTIKAN ADA KELAINAN
ATAU TERPOTONG
SINUS COSTOPHRENICUS
NORMAL :
Kanan lebih tinggi dari kiri (jantung menekan)
Selisih <3 cm)/ atau sebagai patokan tidak lebih
dari 2 vertebra
Licin
Viewing PA radiograph of the chest
Size
Shape
Silhouette-margins should be sharp
Diameter (>1/2 thoracic diameter is enlarged
heart)
Ascites
Straight back syndrome
Pectus excavatum
>50%
Here is a heart that is larger than 50% of the cardiothoracic ratio, but it is still a normal heart. This is
because there is an extracardiac cause for the apparent cardiomegaly. On the lateral film, the arrows
point to the inward displacement of the lower sternum in a pectus excavatum deformity.
MENGENAL SISI YANG MEMBESAR
Pembesaran atrium kiri
LA membesar :
1. Double
countour
apendiks
atrium kiri
yang menonjol
disebabkan
oleh kelebihan
tekanan
atrium kiri .
ARCUS AORTA
Aortic Knob
The first bump on Aortic knob
the left-side is the should
aortic arch. We can measure
measure the knob < 35mm
from the lateral
border of air in the
trachea to the
edge of the aortic
knob.
Aortic Knob
42mm
Enlarged with:
Increased pressure
Increased flow
Changes in aortic wall
MAIN PULMONARY ARTERY
Main
Pulmonary
Artery
Important
Adjacent to left
pulmonary artery
Main
Pulmonary
Artery
Main
Pulmonary
Artery
LV
LV
Main pulmonary
artery ranges from
0 mm15mm
from tangent line
Two Major Classifications
Increased
pressure
Increased flow
Main pulmonary
artery is more
than 15 mm
from tangent
Small pulmonary
artery
Truncus arteriosus
Tetralogy of Fallot
Main pulmonary
artery is more
than 15 mm
from tangent
Left ventricle
and/or aortic
knob push the
tangent away
Common
To
recapitulate: 0 - 15 mm
Left atrial enlargement
Concavity where L
atrium will appear on
left side when
enlarged
Left atrial enlargement
Straightening of the
left heart border
Left atrium
may enlarge
without
producing
double
density
In the example on the Main
right, not only is the Pulmonary
left atrium enlarged, Artery
but the left atrial
Left
appendage is too. So Atrial
there is a convexity Appendage
outward where there
is normally a
concavity inward.
ODEMA PARU
B C
B
Edema alveolar
Jantung terkompensasi
Dekompensasi jantung kanan
Dekompensasi jantung kiri
50 Kardiomegali Gagal jantung kongestif (CHF)
Kardiomiopati terdilatasi (Dilated
cardiomyopathy)
Kardiomiopati peripartum[
Sudut Diagnosis
Apeks Kesan
kardiofrenikus Diferensial
Jantung
terkompensasi
Terbenam / Left ventricle
Dekompensasi
tenggelam 90 enlargement
kordis sinistra
(grounded) (LVE)
Gagal jantung
kongestif (CHF)[1]
Jantung
Right terkompensasi
Terangkat ventricle Dekompensasi
< 90
(rounded) enlargement kordis dekstra
(RVE) Gagal jantung
kongestif (CHF)[1]
Sudut Sudut
Diagnosis
kostofrenikus kostofrenikus Kesan
Diferensial
kanan kiri
Tak ada
Tajam
kelainan
Tumpul atau
Efusi pleura
tertutup Tajam
dekstra
perselubungan
Tumpul atau
Efusi pleura
Tajam tertutup
sinistra
perselubungan
Pulmonary
venous
Mitral
regurg
Mitral
Stenosis
Is the Left then L Myxoma
Vasculature hypertension
Atrium
If no, VSD, PDA
Enlarged?
Increased
then
Plum.
If yes, stenosis
Normal
B
then Look at the
Is the Main ASD
Pulmonary
Pulmonary Increased (VSD)
Artery Big If no, Vasculature
or then Pulmonary Idiopathic
(1)
Bulbous? hypertension
D
Is the Cardiomyopathy
Heart If yes,
Pericardial
Dilated or
Delta- then Effusion
A Straight or
Double convex at
density at site of
site of normal normal
indentation concavity
A
If Answer To Question A Is YES
Look At Pulmonary Vasculature
To answer that question
A
A
If Answer To Question A Is NO
Then...
B
Is The Main Pulmonary
Artery Big ?
To answer that question
B Main
pulmonary
artery projects
beyond
tangent line
B
If Answer To Question B Is YES
Look At Pulmonary Vasculature
B
If Answer To Question B Is NO
Then...
C
Is The Main Pulmonary
Artery Concave ?
C To answer that question
Main
pulmonary
artery is >
15mm
away from
tangent
line
C
If Answer To Question C Is YES
Look At Configuration of Aorta
C
If Answer To Question C Is NO
Then...
D
Is The Heart a Dilated Or
Delta-Shaped Heart ?
D 1. Pericardial effusion
2. Cardiomyopathy
B
Pulmonic
Is the Main stenosis
If yes, Normal
Pulmonary
then Look at the
Artery Big ASD
Pulmonary
or Increased (VSD)
If no, Vasculature
Bulbous? Pulmonary
then arterial Idiopathic
hypertension 2 to lung dz
C
Is the Main
If yes, Normal Cardiomyopathy
Pulmonary Don't Look at
then Pulmonary Ascending
Artery Vasculature. Aortic
Segment
Look at Aorta dilated
If no, Stenosis
Concave? then Whole Aorta Aortic
regurgitation
D Dilated
Is the HBP
Heart
Cardiomyopathy
Dilated or If yes, Pericardial
Delta- Effusion
then
Shaped? Multiple valve dz
THANK YOU FOR YOUR ATTENTION
LATIHAN
Double countour LA Enlargement
Enlarged or not?
Yes
Enlarged or not?
Yes
Enlarged or not?
No