dr. Metrila Harwati, M.Kes, Sp.

Rad
 Konsolidasi/ air-space opacity
 Opasitas interstisial
 Nodul and massa
 Lymphadenopathy
 Kista dan kavitas
 Pleura abnormal
 Terisinya alveoli oleh fluid, pus, blood, cells
(tumor), dll.
 difus, atau terbatas segments/lobus paru
 air bronchograms(ABS)  air-filled bronchus
surrounded by opacified lung (+/-)
 Disease localized to pulmonary interstitium, i.e.,
the alveolar septae and connective tissues that
support the alveoli
 Hallmarks:
 Lines and/or reticulation
 Small, well-defined nodules
 Miliary pattern

 DDX: Pulmonary edema, interstitial lung diseases

(e.g., idiopathic pulmonary fibrosis), sarcoidosis,
infection, tumor (lymphangitic spread), etc
 Nodule: discrete pulmonary lesion, sharply
defined, nearly circular opacity 0.2 - 3 cm
 Mass: larger than 3 cm
 Describe with qualifiers:

 Single or multiple
 Size
 Border characteristics
 Presence or absence of calcification
 Location
 Non-specific terms:
• Mediastinal widening
• Hilar prominence
 Specific patterns:
• Particular station enlargement
(location)
Important to know what “normal” should look like
in order to recognize “abnormal
Image credit: Curry International Tuberculosis Center, University of California, San Francisco 34
 Lymphadenopathy
 Infrahilar window
(right hilar and/or
subcarinal)
 Left hilar
 Subcarinal

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 35
 Right Paratracheal & Bilateral LAN

Image credit: Curry International Tuberculosis Center, University of California, San Francisco 36
 Abnormal pulmonary parenchymal spaces
(“holes”), filled with air and/or fluid, with a
definable wall (>1 mm)
 Cyst: congenital or acquired
 Cavity: caused by tissue necrosis, (inflammatory and/or
neoplastic)

 Characterize:
 Wall thickness at thickest portion
 Inner lining
 Presence / absence of air / fluid level
 Number and location
Aktif
 Berawan/opasitas inhomogen
 Kavitas

Tidak aktif
 Garis2 fibrosis
 Kalsifikasi.
 TB milier  bercak2 milier kedua paru
 Pertama kali terlihat dengan uk. 1 mm
Typical Pattern: Post-primary TB
 Distribution

• Apical / posterior segments of upper lobes

• Superior segments of lower lobes
Patterns of disease
 Air-space consolidation
 Cavitation, cavitary nodule
 Endobronchial spread
 Miliary
 Bronchostenosis
 Tuberculoma
 Pleural effusions
(empyema most likely in
post-primary disease
 Secara radiologi dibagi secara primer dan
sekunder.
 Pneumonia primer terjadi pada paru yang
normal.
 Pneumonia sekunder terjadi akibat kelainan
lain yang telah ada di paru.
Gambaran pneumonia terbagi atas 3:
 Air space (lobar) pneumonia
konsolidasi uniform pada 1 lobus
 Interstitiel pneumonia
 Bronchopneumonia
prosesnya di bagian distal bronchiolus 
patchy infiltrate (proses multifocal).
Gambaran foto thoraks pneumonia lobaris:
 Opasitas homogen/perselubungan yang
mengenai 1 lobus/segmen
 Batas tegas, tepi reguler
 Tidak ada pergeseran/shift organ
mediastinum
 Air bronchogram sign +/-
 Paling sering pada lobus bawah dan segmen
posterior lobus atas.
Bronchopneumonia:
 Patchy airspace beberapa segmen, tanpa
ABS.
 Pola yang nonhomogen dari lobulus yang
patchy  pola ‘a sponge like patterns’
Interstitial pneumonia
 Reticular interstitial
 Biasanya menyebar difus di paru
 Sering menjadi airspace disease
interstitial pneumonia. Transverse CT
image of chest shows bilateral diffuse
groundglass opacities as well as subpleural
fibrotic changes (solid arrows) and
traction bronchiectasis (open arrow) with
bronchial wall irregularities

AJR:201, August 2013

Round pneumonia:
 Spherical pneumonia
 Biasanya lobus bawah anak2.
 Mirip massa.
Cavitary
 Diakibatkan oleh sejumlah mikroorganisme
 Sebagian besar karena TB
Respiratory bronchiolitis–associated
interstitial lung disease in 60-year-old male heavy
smoker with chronic cough. Transverse CT image of
chest shows slight ground-glass opacities as well as
fine centrilobular nodules (thin arrows) and bronchial
wall thickening (thick arrow) in left upper lobe.

AJR:201, August 2013

Tree-in-bud in infective bronchiolitis

Silva et al, The teaching files chest, 46-47,2010.

 Kavitas dinding tebal disetai airfluid level
 Corakan bronchovasculer melewati 2/3 paru.
 Penebalan dinding bronkial di daerah perihilar
Chronic bronchitis: postero-anterior
radiograph (A) and computed tomography
(B) show bilateral bronchial wall
thickening, the so-called, ‘‘dirty lung.’’

2009 Lippincott Williams & Wilkins

 Gambaran radiologi bronchitis kronik dapat tidak
spesifik:
penebalan dinding bronkial & pembuluh
membesar.
 Bronkitis kronik  penebalan dinding
bronkial dan pelebaran arteri di paru.
 Inflamasi berulang  jaringan parut dengan
bronkovaskuler yang irreguler + fibrosis.
 Dilatasi
permanent rongga udara distal
sampai bronchioles terminalis disertai
kerusakan dinding alveolarnya.

David Sutton hal.48, Meschan hal.593 dan 629

Tipe emphysema:
 Pan-acinar emphysema/panlobular
kerusakan paru distal-br.terminalis dan air
trapping.
predileksi: lobus bawah dan bag.anterior
 Centriacinar emphysema
br.respiratorius.
predileksi: 2/3 atas paru terutama
apicoposterior dan lobus bawah segmen sup.

David Sutton hal.48, Meschan hal.593 dan

 Paracicatrical emphysema
distensi dan destruksi br.terminal yg dekat
dengan fibrosis, biasanya sekunder dari TB.
 Obstructive emphysema/obs.hiperinflation
udara masuk pd saat inspirasi dan terjebak
saat ekspirasi. Dilatasi distal tapi tidak rusak.
 Compensatory emphysema/hiperinflation
respon terhadap kolaps
 Bulla  emphysematous space, diameter > 1
cm.
David Sutton hal.48, Meschan hal.593 dan
 Hiperinflasiparu  hiperlusen vaskuler paru
 Penurunan vaskuler paru perifer
 Peningkatan diameter thoraks
 Sternum ‘anterior bowing’
 Diafragma letak rendah/datar
 ICS melebar
 Costa cenderung horizontal  ‘barrel chest
app’
 Jantung ramping/ ‘hanging drop appearance’
 Bila terjadi hipertensi pulmonal 
a.pulmonal dilatasi.
 Bila terdapat cardiomegaly  cor pulmonale
 Emphysema dengan bronchitis kronik:
- hiperinflasi.
- hipertensi a.pulmonal.
- peningkatan corakan bronchovasculer.
Congenital Lobar Emphysema
 Distress pernafasan pada infant.
 Hampir selalu unilateral.
 Lobus atas dan medius
 Lobus yg terkena hiperinflasi  kompresi
lobus lain dan deviasi mediastinum
kontralateral.
CT Scan Paru – paru menggambarkan densitas
yang tidak homogen pada penderita PPOK
Bullous emphysema: postero-anterior radiograph and
coronal computed tomography multiplanar reformation
and
maximum intensity projection images show a large bulla
in the right upper lobe with atelectasis of the adjacent
lung (arrows).
J Thorac Imaging Volume 24, Number 3, August 2009
COPD: Radiology-Pathology Correlation
Loss of volume sebagian atau seluruh paru.
Dibagi atas:
 Passive atelectasis  pneumothoraks, efusi
pleura
 Retractive atelectasis  fibrosis paru
 Addhesive atelectasis  surfactant
abnormal.
 Resorptive atelectasis  obs.bronchial
Direct sign:
 Displaced of fissure
 Loss of aeratio  collaps lung
 Vascular and bronchi may be crowded
 Indirect sign:
 Elevasi hemidiafragma
 Mediastinal displacement
 Hilar displacement
 Compensatory hyperinflation
 Golden S sign
 Abnormal dan dilatasi irreversible bronchus
dan bronchiolus, akibat chronic necrotizing
infection
 Bilateral  50% kasus.
 Biasanya pada segmen basal lobus bawah.
Gambaran radiologi:
 ‘honey comb appearance / cincin2 lusen.
 Bila disertai dengan infiltrat  infected
bronchiectasis.
Bila:
 Dilatasi bronchus terlihat end-on  ring
shadow
 Dilatasi bronchus disertai penebalan dinding
 tramline shadow
 Dilatasi bronchus disertai cairan yang mengisi
bronchus  gloved finger shadow.
 Jinak
soliter, batas tegas, tepi reguler, kalsifikasi
(+).
 Ganas:
tepi irreguler, spiculated, tail sign, batas
tidak tegas, kalsifikasi -/jarang.
Primer: Bronchogenic ca  perifer dan
sentral.
Sekunder: metastasis

Meschan
 Cavity of Squamous Cell Carcinoma Lung
 Thick wall
 Irregular lumen
 Left hilar fullness: Nodes

Chest X-ray Atlas

A.J. Chandrasekhar, M.D.
Bentuk gambaran metastasis tumor di paru.
 Nodul multiple
 Kavitas
 Nodul soliter
 Limfangitis karsinomatosa  retikuler, liner,
kasar, dan noduler basal sering disertai efusi
pleura dan limfadenopati hilus.
 Metastasis milier
 Metastasis endobrochial  paru kolaps.
 Multiple “coin lesion”
 Penimbunan cairan yang berlebihan di
jaringan interstitiel dan alveolar paru
 Secara fisiologis: edema paru kardiogenic
dan non kardiogenic
 Secara anatomi: edema paru interstitiel dan
alveolar.
 Bercak2 tipis  radiolusen paru bawah
menjadi suram
 Penebalan septa interalveolar  kerley B
line dan A line.
 Perkabutan tipis di hilus  batas pembuluh
darah kabur.
 Perselubungan/fluffyparahilar maupun
parakardial ka/ki  butterfly atau batwing
appearance