CHEST RADIOLOGY

Dr. Hari Soekersi, Sp.Rad.

Posteroanterior Projection1

Lateral Projection2

Right Anterior Oblique Projection3

Left Anterior Oblique Projection4

NORMAL FOUR VIEWS OF THE HEART

1. Right innominate vein2. Superior vena cava3. Right main branch of the pulmonary artery4. Upper and lower lobe veins5. Right atrium6. Tricuspid valve7. Inferior vena cava8. Arch of the aorta

9. Left main branch of the pulmonary artery10. Main pulmonary artery11. Left upper lobe vein12. Appendage of the left atrium13. Mitral valve14. Left ventricle15. Right ventricle

POSTEROANTERIOR PROJECTION

POSTEROANTERIOR PROJECTION

POSTEROANTERIOR PROJECTION

POSTEROANTERIOR PROJECTION

Right Atrium

Superior vena cava

Left Ventricle

Appendage of the left atrium

Pulmonary artery

Aorta

1. Superior vena cava2. Ascending aorta3. Main pulmonary artery4. Right atrium5. Tricuspid valve6. Right ventricle7. Aortic arch8. Left main branch of the pulmonary artery

9. Left atrium10. Mitral valve11. Left ventricle12. Descending aorta13. Inferior vena cava

LATERAL PROJECTION

LATERAL PROJECTION

LATERAL PROJECTION

LATERAL PROJECTION

Right Ventricle

Root of the main pulmonary artery

Left Ventricle

Left Atrium

Because these structures are in contact with mediastinal fat, their margin may be indistinct

1. Anterior wall of the trachea2. Innominate vein3. Anterior border of the superior vena cava4. Superior vena cava5. Right main branch of the pulmonary artery6. Thoracic aorta7. Left atrium8. Right atrium9. Inferior vena cava

10. Left innominate vein11. Arch of the aorta12. Left main branch of the pulmonary artery13. Main stem of the pulmonary artery14. Left main bronchus15. Tricuspid valve16. Mitral valve17. Right ventricle18. Left ventricle

RIGHT ANTERIOR OBLIQUE PROJECTION

RIGHT ANTERIOR OBLIQUE PROJECTION

1. Superior vena cava2. Right main branch of the pulmonary artery3. Ascending aorta4. Main pulmonary artery5. Right atrial appendage6. Tricuspid valve7. Right ventricle8. Left subclavian artery

9. Posterior border of the trachea10. Left main branch of the pulmonary artery11. Left main bronchus12. Left atrium13. Mitral valve14. Left ventricle15. Inferior vena cava

LEFT ANTERIOR OBLIQUE PROJECTION

LEFT ANTERIOR OBLIQUE PROJECTION

ANATOMY OF THE HEART

HISTOLOGY OF THE HEART

2. Myocardium of atrium

1. Endocardium of atrium

3. Annulus fibrosus

4. Mitral valve :a. Endocardiumb. Connective tissue

core

5. Chorda tendina

6. Endocardium of ventricle

7. Myocardium of ventricle

8. Purkinje fibers (conduction fibers)

10. Coronary artery

9. Plate A

11. Coronary sinus

12. Coronary vein with valve

13. Epicardium of atrium

14. Subepicardial connective tissue and fat

15. Perimysial septa with blood vessels

16. Epicardium and subepicardium of ventricle

17. Columnae carneae

18. Apex of papillary muscle

Analyze each case with six steps:

PLAIN FILMS DIAGNOSIS OF CARDIAC DISEASE

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34 5

6

Analyze each case with six steps:

PLAIN FILMS DIAGNOSIS OF CARDIAC DISEASE

EVALUATION OF THE THORACIC CAGE FOR SIGN OF PREVIOUS SURGERY OR OTHER

ABNORMALITIES

IDENTIFICATION OF THE POSITION OF THE STOMACH BUBBLE AND HEPATIC SHADOW TO

DETERMINE BODY SITE

EVALUATION OF GREAT VESSELS FOR SIZE AND POSITION

EVALUATION OF SPECIFIC CHAMBER ENLARGEMENT

EVALUATION OF CARDIAC SIZE AND CONTOUR

EVALUATION OF PULMONARY VASCULARITY

Signs of previous surgery

- periosteal elevation- asymmetry thoracic cage- smaller and slightly deformed rib- resected rib in previous thoracotomy

EVALUATION OF THE THORACIC CAGE FOR SIGN OF PREVIOUS

SURGERY OR OTHER ABNORMALITIES

1

Congenital heart disease:

- premature fusion of sternum→ cyanotic form- hypersegmentation of sternum → Down’s syndrome

- bulging of sternum → enlarged right ventricle

EVALUATION OF THE THORACIC CAGE FOR SIGN OF PREVIOUS

SURGERY OR OTHER ABNORMALITIES

1

COMPLETE FUSION OF STERNAL SEGMENTS

HYPERSEGMENTATION OF THE STERNUM

ATRIAL SEPTAL DEFECT WITH ENLARGED RIGHT VENTRICLE AND

ANTERIOR BULGING OF THE STERNUM

Abnormal hepatic and stomach position show

abnormalities in position of the viscera congenital

cardiac disease

IDENTIFICATION OF THE POSITION OF THE STOMACH

BUBBLE AND HEPATIC SHADOW TO DETERMINE BODY SITE

2

SITUS SOLITUS WITH DEXTROCARDIA

Stomach bubble is under the left diaphragmLiver is on the rightHeart is on the right with cardiac axis directed to the right

SITUS INVERSUS WITH DEXTROCARDIA

Stomach bubble is under the right diaphragmLiver is on the leftHeart is on the right with cardiac axis directed to the right

ISOLATED LEVOCARDIA OR SITUS AMBIGUS

Stomach bubble is under the right diaphragmLiver is on the leftNormal heart position

DEXTROCARDIA

Dextrocardia :Location of the heart in the right side of the thorax, the apex pointing to the right

Dextroversion :Location of the heart in the right chest, the left ventricle remaining in the normal position on the left with the apex pointing the the left

DEXTROVERSION

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Enlargement of the pulmonary artery segmentProminent pulmonary arterial segment along the left upper cardiac borderIn TGV and truncus arteriosusabnormal position (concave)

Enlargement of the aortaThree portions of the aorta can be evaluated: ascending aorta, aortic arch dan descending aorta.

EVALUATION OF GREAT VESSELS FOR SIZE AND POSITION3

ENLARGEMENT OF PULMONARY ARTERY SEGMENT

TRANSPOSITION OF GREAT VESSELS

TRANSPOSITION OF GREAT VESSELS

TRUNCUS ARTERIOSUS

TRUNCUS ARTERIOSUS

ENLARGEMENT OF THE AORTA

Usually, the ascending aorta does not extend

beyond the right upper mediastinal shadow.Here, there is enlargement of the aorta.

Signs of left atrial enlargementSigns of left ventricular enlargementSigns of right atrial enlargementSigns of right ventricular enlargement

EVALUATION OF SPECIFIC CHAMBER ENLARGEMENT4

Posteroanterior projection1. Displace the barium-filled esophagus below the

carina to the right2. Prominent bulge along the mid-left cardiac border3. A double density along the right cardiac border4. Widening of the angle of the carina >900

Lateral projection1. Posterior displacement of both walls of the

barium-filled esophagus

SIGNS OF LEFT ATRIAL ENLARGEMENT

Left anterior oblique projectionElevate the left mainstem bronchus and obliterates the spaces between the posterior cardicac margin and the left mainstem bronchus

SIGNS OF LEFT ATRIAL ENLARGEMENT

LEFT ATRIAL ENLARGEMENT

Posteroanterior projection1. Left ventricular dilatation produces downward

displacement of the apex toward diaphragm.2. Left ventricular hypertrophy produces a round left

cardiac borderLeft anterior oblique projection

Posterior cardiac margin to overlap the vertebral column

SIGNS OF LEFT VENTRICULAR ENLARGEMENT

LEFT VENTRICULAR DILATATION

LEFT VENTRICULAR HYPERTROPHY

Posteroanterior projectionDifficult increased convexity of the lower right heart

border on PA projection

SIGNS OF RIGHT ATRIAL ENLARGEMENT

RIGHT ATRIAL ENLARGEMENT

SIGNS OF RIGHT VENTRICULAR ENLARGEMENT

Posteroanterior projectionRounding and elevation of the cardiac apexLateral projection

Retrosternal space is obliteratedLeft anterior oblique projection

Increased convexity of the anterior cardiac border

RIGHT VENTRICULAR ENLARGEMENT

Index of cardiac enlargement is the cardiothoracic ratio.In infants: 0.55In adults : 0.45The lateral and oblique views must be considered

EVALUATION OF CARDIAC SIZE AND CONTOUR5

CARDIOTHORACIC RATIO

(Cardiac width / Thoracic cage width) x 100%

In normal the pulmonary vascular marking taper gradually toward the periphery of the lung fields, and more prominent in the lower lung fields.The vessels in the right hillum is larger than in the left

EVALUATION OF PULMONARY VASCULARITY6

1. Normal pulmonary vascularity2. Increased pulmonary vascularity due to increased

pulmonary blood flow.- the peripheral arteries are sharply outlined and dilated and distributed equally to both the upper and lower lobes.- ex. VSD, PDA, truncus arteriosus, transposition of the great vessels.

SIX DIFFERENT VASCULAR PATTERNS ARE RECOGNIZED

3. Decreased pulmonary vascularity due to right-to-left shunts.- small pulmonary arterial segment- reduced diameter of the hilar pulmonary arteries- ex. Tetralogy of Fallot, tricuspid atresia,

pulmonary stenosis

4. Pulmonary venous congestion- occurs in condition that causes increased resistance distal to pulmonary capillaries- fluid accumulates in the interstitial tissues and Kerley B lines- ex. Mitral stenosis, acute left ventricular failure are common causes.

5. Bronchial collateral

6. A bizarre pattern of pulmonary vascularity- different vascular pattern in each lung

• Five factors influence the distribution of pulmonary blood flow.

• Interstitial osmotic and alveolar pressures remain constant throughout the lung

• Hydrostatic, pulmonary arterial and pulmonary venous pressures, diminish from base to apex because of gravitational effects.

• In left-sided cardiac failure, the increased pulmonary venous pressure resulting from the elevated left ventricular end-diastolic pressure

PULMONARY VASCULARITY IN LEFT-SIDED FAILURE

• The transudation of fluid into the pulmonary interstitium causes an increase in the interstitial pressure

• The earliest radiographic manifestation on left-sided cardiac failure is:1. An indistinctness of the vascular markings caused

by the increased interstitial fluids.2. The hilar vessels become enlarged and indistinct.3. The increased interstitial fluid can be seen as

‘peribronchial cuffing’.

• Later, ‘cephalization’ occurs. The vascular markings are prominent in the upper lobes owing to the constriction of the lower lobe vessels and redistribution of flow to the upper lobes.

• Pleural effusion occurs late• Transudation of fluid into the alveoli leads to pulmonar

edema. This appears in a perihilar location (‘butterfly wings’ or ‘bat wings’).

• Kerley B lines, due to fluid in the lobular septum.

Several non-cardiac causes as differential diagnosis of pulmonary edema:1. Uremia. Increased capillary permeability.2. Fluid overload. Decreased plasma osmotic pressure.3. Neurogenic. Altered capillary permeability or capillary pressure.4. Hypoproteinemia. Decreased plasma osmotic pressure.5. Transfusion and allergic reactions. Altered capillary

permeability.6. Inhalation of toxic gases. Altered capillary permeability

CEPHALIZATION

KERLEY B

KERLEY A, B, & C

• Kerley A : white arrow• Kerley B : white arrow head• Kerley C : black arrow head

EDEMA PARU INTERSTITIAL

EDEMA PARU ALVEOLAR

PULMONARY VASCULARITY IN PULMONARY HYPERTENSION

• Pulmonal artery segment dilatation• Right ventricular enlargement• Reduced bronchovascular marking

Mild PAH Severe PAH

1. Decrease bronchovascular marking

a) Acyanotic1. Pulmonary Stenosis (PS)

b) Cyanotica) Tetralogy Fallotb) Trilogy Fallotc) Atresia Pulmonald) Atresia Tricuspide) Ebstein Anomaly

CONGENITAL HEART DISEASE

2. Increase bronchovascular marking

a) Acyanotic1. Atrial septal defect (ASD)2. Ventricle septal defect (VSD)3. Right atrioventricular anomaly4. Patent ductus arteriosus (PDA)5. Partial Anomalous Pulmonary

Venous Return (PAPVR)

b) Cyanotic1. Total Anomalous Pulmonary

Venous Return (TAPVR)2. Truncus Arteriosus3. Transposition of the Great Vessels

(TGV)

PULMONARY STENOSIS

PULMONARY STENOSIS

Pulmonary stenosis make right ventricular resistancy increased, causing radiographic feature:• Right ventricular enlargement• Rounding and elevation of the cardiac apex• Bulging of pulmonary trunc• Bronkhovascular marking decreased

TETRALOGY FALLOT

TETRALOGY FALLOT

The malformation has four components:Right ventricular hypertrophy, Overriding aorta, Pulmonary stenosis, and Ventricular septal defectRadiographic features:• Right ventricular enlargement• Boot shape contour• Pulmonary artery segment concave• Right sided aortic arch• Pulmonary vascularity decreased

EBSTEIN ANOMALY

EBSTEIN ANOMALY

• Atrial septal defect• Displace tricuspid valveRadiographic feature:• Vary • Widening of right heart border• Rounded heart (cardiomegali all chamber)• Bronchovascular marking decreased

ATRESIA PULMONAL

ATRESIA PULMONAL

Radiographic feature:• Cardiomegali with oval heart contour• Bronchovascular marking decreased

ATRESIA TRICUSPID

ATRESIA TRICUSPID

• ~ Atresia pulmonal• Cardiomegali with oval heart contour• Pulmonary vascularity decreased

ATRIAL SEPTAL DEFECT

ATRIAL SEPTAL DEFECT

The feature related to how large the defect and the complication on the pulmonary vascularityRadiographic feature:• Right atrial enlargement, widening right heart border• Right ventricular enlargement, rounded and

elevation of the cardiac apex• Prominent conus pulmonalis, with widening of hillum• Bronchovascular marking increased• Signs of pulmonary hypertension

VENTRICULAR SEPTAL DEFECT

VENTRICULAR SEPTAL DEFECT

Radiographic feature:

• Small defect (Maladie de Roger)• Heart is not enlarged• Normal pulmonary vascularization

• Mild • Heart is enlarged to the left (left ventricle hypertrophy)• Apex downward to the diaphragm.• Right ventricle has not enlarged.• Left atrium dilated• Increase pulmonary vascularization.

VENTRICULAR SEPTAL DEFECT

Radiographic feature:• Moderate – Severe

• Right ventricle dilatation and hypertrophy.• Left atrium dilatation.• Widening of the pulmonary artery and its branches• Normal right atrium.• Left ventricle hypertrophy.• Small aorta.

• Pulmonary hypertension• Right ventricle is enlarged.• Pulmonary artery is widening with prominent of conus pulmonalis.• Normal left atrium.• Small aorta.• Decrease peripheral pulmonary vasculature.• Pulmonary emphysematous

PATENT DUCTUS ARTERIOSUS

PATENT DUCTUS ARTERIOSUS

• Small defect– Normal

• Moderate– Normal or mild enlargement of descendent aorta and

aortic arch.– Prominent of conus pulmonary.– Widening of the pulmonary artery and its branches.– Left atrial enlargement.– Right and left ventricle enlargement.

PATENT DUCTUS ARTERIOSUS

• Severe (pulmonary hypertension)– Enlarge central pulmonary vasculature.– Decrease peripheral pulmonary vasculature.– Prominent conus pulmonalis.– Widening of the ascendent aorta with prominent

aortic knob.– Normal left atrium.

Terima kasih

KARDIOVASKULER PATOLOGIS

CHD

• Dengan Pembuluh darah paru bertambah

Tanpa Cyanosis

Dengan Cyanosis

ASD

VSD

ECD

PDA

PAPVRTAPVR

Trunkus Arteriosus Persisten

Transposisi Pembuluh darah besar

CHD• Gambaran Pembuluh darah paru yg berkurang

Tanpa sianosis

Dengan sianosis

Pulmonal stenosisvalvuler

infundibuler

supravalvulerHipertensi Pulmonal primer

TOF

Trilogi of Fallot

Atresia pulmonalis

Atresia tricuspidalis

Ebstein anomali

VSD

Kelainan jantung bawaan yang paling sering ditemukan di masyarakat, selain gejala klinis untuk mendiagnosa VSD diperlukan pemeriksaan radiologi foto torak PA atau AP dan lateral.

VSD adalah suatu kelainan jantung bawaan dimana terjadi kebocoran pada septum interventrikuler yang menyebabkan gambaran pembesaran jantung dengan corakan bronkovaskuler yang bertambah atau berkurang pada keadaan yang lebih lanjut.

PATOFOSIOLOGI

• Defek pada septum interventrikuler kebocoran darah dengan arah aliran dari kiri ke kanan jumlah darah di ventrikel kanan dan arteri pulmonalis bertambah .

GAMBARAN RADIOLOGI

Kebocoran yang sangat kecil : jantung tidak membesar, dan pembuluh darah paru-paru normal

Kebocoran ringan : jantung membesar ke kiri, apex menuju ke diafragma, pembuluh darah paru-paru bertambah

Kebocoran sedang - berat, ventrikel kanan dilatasi dan hipertrofi, atrium kiri dilatasi, pembuluh darah paru-paru bertambah.

Keadaan dengan hipertensi pulmonal , ventrikel kanan membesar, hilus tampak melebar, pembuluh darah paru-paru berkurang.

X-Ray chest PA View of a chid with ventricular septal defect and left to right shunt and hyperdynamic pulmonary hypertension. There is cardiomegaly, prominent main pulmonary artery segment and right pulmonary artery. Enlarged left pulmonary artery shadow is seen below the lef cardiac border, within the cardiac silhouette. The enhanced vascular markings are visible on the right side whereas it is obscured by the cardiac shadow on the left side. This child needs cardiac cathterisation for evaluation of shunt and pulmonary vascular resistance and its reversibility to decide on surgical option.

ASD

• ASD adalah suatu kelainan jantung bawaan dimana terjadi kebocoran pada septum interatrial yang menyebabkan gambaran pembesaran jantung dengan corakan bronkovaskuler yang bertambah atau berkurang pada keadaan yang lebih lanjut.

PATOFISIOLOGI

• Defek pada septum interatrial kebocoran darah dengan arah aliran dari kiri ke kanan jumlah darah di atrium, ventrikel kanan dan arteri pulmonalis bertambah.

GAMBARAN RADIOLOGI

• Pembesaran jantung kanan (atrium dan ventrikel), corakan bronkovaskuler bertambah. Pada keadaan dengan hipertensi pulmonal , hilus tampak melebar dengan pembuluh darah paru-paru berkurang

X-ray Torax ASD X-ray Dada ASD sertaHipertensi Arteri Pulmonar

BENDUNGAN PARU

• Bendungan vaskuler paru(arteri dan vena) biasanya terjadi disebabkan oleh peningkatan tekanan di atrium kiri yang biasanya disebabkan oleh kelainan katup mitral.

• Kelainan katup mitral dapat disebabkan oleh : - Rhematic fever- Viral- Bakteri streptokokus

PATOFISIOLOGI

• Darah banyak terakumulasi pada jantung kiri , hal ini menyebabkan darah dari vena pulmonalis terbendung.

GAMBARAN RADIOLOGI

• Pada foto torak akan tampak vena-vena pulmonalis yang melebar disekitar hilus (kranialisasi), disusul dengan bendungan pada arteri pulmonalis (hilus melebar).

Kranialisasi (cephalisation)

Cephalization: Vessels in upper chest is more prominent as a manifestation of pulmonary venous hypertension.

EDEMA PARU

• Edema paru merupakan akumulasi cairan yang terdapat pada ruang interstitial atau ruang alveolar.

• ETIOLOGI :• Kardiogenik • Non kardiogenik

PATOFISIOLOGI

Pada keadaan-keadaan patologis tertentu dimana terjadi peningkatan tekanan di dalam kapiler-kapiler pembuluh darah paru peningkatan permeabilitas pembuluh darah, atau perubahan tekanan osmose darah akan menyebabkan cairan didalam pembuluh darah keluar ke interstitial, apabila pembuluh limfe sudah tidak mampu mengkompensasi maka terjadilah akumulasi cairan pada ruang interstitial atau ruang alveolar.

Patofisiologi edema paru

GAMBARAN RADIOLOGI

• Pada foto torak edema interstitial akan tampak garis-garis septa (garis Kerley), pada edema alveolar tampak bercak-bercak yang tebal di kedua perihiler sehingga batas-batas pembuluh darah menjadi suram.

Pulmonary edemaAlveolar

Pulmonary Alveolar Edema. There is extensive, bilateral airspaces disease with fluid in the minor fissure (blue arrow) and bilateral pleural effusions (ref arrows). Although the heart is not enlarged, the cause was still on a cardiogenic basis.

Pulmonary edemaintestitial

ARDS/non cardiogenic pulmonary edema

Adult Respiratory Distress Syndrome Non-cardiogenic pulmonary edema Distinguishing characteristics: Normal size heartNo pleural effusion

KELAINAN KATUP MITRAL

Kelainan katup mitral yang sering adalah mitral stenosis dan mitral insufisiensi (kebocoran). Mitral stenosis merupakan keadaan dimana katup mitral tidak dapat terbuka sempurna, sedangkan pada mitral isufisiensi, katup mitral tidak dapat tertutup sempurna.

ETIOLOGI- Rheumatic fever- Viral- Bakteri streptokokus

PATOFISIOLOGI Keadaan akut : terjadi kelemahan-kelemahan pada katup dan

chorda tendinea, sehingga mula-mula terjadi insufisiensi katup, Bila keadaan menjadi kronis, terjadilah penyempitan dari katup,

karena terjadi pengerutan dan perlekatan-perlekatan katup dan cincin katup, sehingga lubang mitral menjadi sempit dan kecil.

Mitral stenosis darah banyak terakumulasi pada atrium kiri . Mitral insufisiensi : regurgitasi darah dari ventrikel kiri ke atrium

kiri pada keadaan systole, sehingga pada diastole darah yang diterima oleh ventrikel kiri jumlahnya meningkat, terjadilah dilatasi dan hipertrofi.

GAMBARAN RADIOLOGI

• Pada mitral stenosis terjadi pembesaran dari atrium kiri, sedangkan pada mitral insufisiensi terjadi pembesaran dari atrium maupun ventrikel kiri yang disertai oleh gambaran kranialisasi.

Mitral stenosis

• Ukuran jantung > • Apex terangkat• LA > , LV N, • RV >• Aortic arch <• vascular markings,

terutama suprahilar• Double contour

Mitral StenosisSTENOSIS MITRALRADIOLOGIS :1. P A :• BATAS KIRI MENONJOL• DOUBLE CONTOUR BATAS KANAN• APEX BULAT• BRONCHUS KIRI TERANGKAT• VASKULARISASI BERTAMBAH2. LATERAL DAN RAO :• ESOPHAGUS TERDORONG3. LAO :• ATRIUM KIRI MEMBESAR DI BAWAH BRONCHUS

Etiologi : endokarditis rheumatika. Akut : kelemahan katup & corda tendinea insufisiensi katup kronis pengerutan katup lubang katup kecil (sampai 0,5 cm, N : 4-6cm)

Ro:Ringan : LA dilatasi.Moderat & berat : 1. Dilatasi LA : pendorongan esofagus, double kontur batas

kanan, aurikel LA menonjol, bronkhus utama kiri terangkat,2. aorta mengecil, a. pulmonalis menonjol,3. RV hipertrofi apex membulat, mitral konfiguration4. Paru : makin berat makin banyak vena tampak. Hipertensi

vena disusul hipertensi arteri hilus melebar5. Edema paru, kerley, hemosiderosis,

Radiograph of the heart: The abnormalities characteristic of mitral stenosis are more expressed in this case. The

heart is enlarged, the dilatation of the left ventricle (arrow) is associated with the dilatation of the right ventricle.

Left atrial enlargement, dilated pulmonary arteries and left atrial calcification seen in the chest X-ray of a patient with severe MS

MS- endocarditis rhematika- N: 4 cm, stenosis : 0,5 cm- Faktor : tek LA & LV meningkat, RV

meningkat PH arterial, aliran darah menurun ke LV & aorta

- Ro : - RV & LA >- LV N, aorta kecil- CBV suprahilar >- Pinggang jantung menonjol- Double contour sisi kanan- Konfigurasi mitral

KOMBINASI STENOSIS MITRAL DAN INSUFISIENSI MITRALA. ATRIUM KIRI LEBIH BESARB. APEX MELEBAR KE KIRI DAN KE BAWAHC. RAO : ESOPHAGUS TERDORONG DI BAWAHD. VASKULARISASI BERTAMBAH

COR PULMONALE

COR PULMONALE adalah kelainan dari jantung terutama jantung kanan (ventrikel kanan) karena adanya kelainan-kelainan pada paru yang menyebabkan hambatan besar pada sirkulasi jantung paru-paru.

ETIOLOGI : Akut : Emboli pulmonal, kompresi atelektasis, tension

pneumotorak, reseksi paru Kronis: empisema, bronchitis kronis, fibrosis paru,

tuberkulosis luas, karsinoma paru

PATOFISIOLOGI

Pada keadaan normal terdapat keseimbangan antara luasnya penampung pembuluh darah dengan volume darah yang mengalir didalamnya. Bila luasnya pembuluh darah ini berkurang , maka timbul hambatan-hambatan pada sirkulasi darah, dan menyebabkan hipertensi pulmonal, dan jantung kanan terutama ventrikel kanan mempunyai beban yang berat sehingga menjadi hipertrofi

GAMBARAN RADIOLOGI

• Pertama terdapat kelainan pada paru-paru, diikuti oleh hilus yang melebar dan menyempit di bagian perifernya, jantung kanan terutama ventrikel kanan tampak membesar.

Cor Pulmonale Deff :kelainan jantung t.u kanan (RV) krn kelainan paru hambatan besar pada sirkulasi jantung paru(krn luasnya PD berkurang oleh suatu sebab hambatan2 sirkulasi darah hipertensi pulmonal.- Akut : pulmonal emboli, kompresi atelektasis, tension

pneumotho, setelah reseksi paru.- kronis : emfisema, bronkitis kronis, fibrosis paru, TB

luas, penyebaran hematogen Ca paru.- Jantung kanan (RV) beban berat hipertrofi jalur

keluar a. pulmonalis membesar.

Rontgen : 1. Kelainan pada paru2. Cardiomegali ke kiri dengan apex membulat di atas diafragma

( RV) , a. pulmonalis segmen menonjol, a. pulmonalis sentral & hilus melebar, bag perifer menyempit.

3. Radiolusen paru bertambah emfisema paru.4. LA & LV tdk membesar, aortabiasa atau mengecil , V.

Pulmonalis tdk tampak.