interpretasi foto dada
TRANSCRIPT
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RIZKI ALIANA AGUSTINA
Ski l l Lab
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Identitas pasien
Exposure
Overexposure
Underexposure
Overexposurecauses a film to be too dark. Underthese circumstances, the thoracic spine, mediastinalstructures, and retrocardiac areas are well seen, butsmall nodules and the fine structures in the lungcannot be seen.
Underexposurecauses the film to be quite white.This is a major problem for adequate interpretation. Itwill make small pulmonary blood vessels appearprominent and may lead you to think that there aregeneralized infiltrates when none is really present.
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First determine is the film a PA or AP view.
PA- the x-rays penetrate through the back of the patienton to the film
AP-the x-rays penetrate through the front of the patienton to the film.
All x-rays in the ICU are portable and are AP view
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Portable (AP or Antero-posterior) PA (Postero-anterior)
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PA AP
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Breath Inspiration
Expiration
Count the number of ribs above the diaphragm. Anterior end of 6-7thrib should be above the
diaphragma
Post end of 9-10thrib
Poor inspiration will make the heart look larger,
give the appearance of basal shadowing &
cause the trachea to appear deviated to the right.
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Bony Framework
Soft Tissues
Lung Fields and Hila
Diaphragm and Pleural Spaces
Mediastinum and Heart
Abdomen and Neck
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PA View:1. Aortic arch2. Pulmonary trunk
3. Left atrial appendage4. Left ventricle5. Right ventricle6. Superior vena cava7. Right hemidiaphragm
8. Left hemidiaphragm9. Horizontal fissure
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Lateral View:
1. Oblique fissure
2. Horizontal fissure3. Thoracic spine and
retrocardiac space
4. Retrosternal space
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Check name & date.
Identify diaphragms:
1: right hemidiaphragm: can beseen to stretch across the
whole thorax & clearly seenpassing through the heartborder.
2: left hemidiaphragm: seemsto disappear when it reaches
the post border of the heart.
Costophrenic angles.
3: Gastric air bubble.
How to look at the lateral film
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To accurately localize a lesion on
CXR, we need to look at both
the PA & lateral films.
PA film:
Horizontal fissure.
Borders of the lesion: if the
lesion is next to a dense (white)
structure, the border will be lost
silhouette sign. RML lesion obscures part of
the heart border.
RLL lesion obscures the
border of the diaphragm.
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Cardiac Silhouette
1. R Atrium
2. R Ventricle
3. Apex of L Ventricle
4. Superior Vena Cava
5. Inferior Vena Cava
6. Tricuspid Valve
7. Pulmonary Valve
8. Pulmonary Trunk
9. R PA 10. L PA
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Post border:
Left ventricle.
Ant border:
Right ventricle.
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Draw an imaginary line from the
apex of the heart to the hilum.
The pulmonic & aortic valvesgenerally sit above this line and
the tricuspid & mitral valves sit
below.
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Liquid density Increased air density
Generalized Localized
Diffuse alveolar
Diffuse interstitialMixed
Vascular
Infiltrate
Consolidation
CavitationMass
Congestion
Atelectasis
Localized airway obstruction
Diffuse airway obstructionEmphysema
Bulla
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1. Identification of abnormal shadows
2. Localization of lesion
3. Identification of pathological process
4. Identification of etiology5. Confirmation of clinical suspension
Complex problems
Introduction of contrast medium
CT chest MRI scan
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Nodule: any pulmonary lesion represented
in a radiograph by a sharply defined,
discrete,nearly circular opacity 2-30 mm indiameter
Mass: larger than 3 cm
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Qualifiers: single or multiple
size border definition
presence or absence of calcification
location
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NODULES
MASSES
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MASSES
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Cyst: abnormal pulmonary parenchymal space, not
containing lung but filled with air and/or fluid, congenital
or acquired, with a wall thickness greater than 1 mm
epithelial lining often present
Cysts & Cavities
Benign Lung Cyst : PCP Pneumatocele
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Benign Lung Cyst : PCPPneumatocele
Uniform wall thickness
1 mmSmooth inner lining
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Cavity: abnormal pulmonary parenchymal
space, not containing lung but filled with
air and/or fluid, caused by tissue necrosis,with a definitive wall greater than 1 mm in
thickness and comprised of inflammatory
and/or neoplastic elements
Benign Cavities :
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Benign Cavities :
Cryptococcus
max wall thickness 4 mm
minimally irregular inner lining
Benign Cavities :
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Benign Cavities :
Cryptococcus
max wall thickness 4 mm
minimally irregular inner lining
Indeterminate Cavities
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Indeterminate Cavities
max wall thickness 5-15 mm
mildly irregular inner lining
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Alveolar space filledwith inflammatoryexudate
WBC, bacteria,plasma, and debris
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Increased heart size:cardiothoracic ratio>0.5
Large hila with
indistinctmarkings
Fluid in
interlobarfissures
Pleural effusions,
alveolar edema
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Congestion Interstitial and
alveolar edema Collapsed or
distended alveoli
Bilateral
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No ventilation to lobebeyond the obstruction
Trapped air absorbed by
pulmonary circulation Segmental/lobar density Compensatory hyper-
inflation of normal lungs.
TUBERKULOSIS
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kuliah terpadu
TUBERKULOSIS
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P th k
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Pneumothoraks
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Fungus ball
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Pneumonia lobaris
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A single, 3cm relatively thin-walled cavity is noted in the left
midlung. This finding is most typical of squamous cell carcinoma
(SCC). One-third of SCC masses show cavitation
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LUL Atelectasis: Loss of heart borders/silhouetting. Notice
over inflation on unaffected lung
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Right Middle and Left Upper Lobe Pneumonia
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Cavitation:cystic changes in the area of consolidation due to the
bacterial destruction of lung tissue. Notice air fluid level.
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Cavitation
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Tuberculosis
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COPD: increase in heart diameter, flattening of the diaphragm, and
increase in the size of the retrosternal air space. In addition the
upper lobes will become hyperlucent due to destruction of the lung
tissue.
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Chronic emphysema effect on the lungs
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Pseudotumor: fluid has filled the minor fissure creating a density thatresembles a tumor (arrow). Recall that fluid and soft tissue are
indistinguishable on plain film. Further analysis, however, reveals a
classic pleural effusion in the right pleura. Note the right lateral gutter
is blunted and the right diaphram is obscurred.
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Pneumonia:a large pneumonia consolidation in the right lower
lobe. Knowledge of lobar and segmental anatomy is important in
identifying the location of the infection
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CHF:a great deal of accentuated interstitial markings,
Curly lines, and an enlarged heart. Normally indistinct
upper lobe vessels are prominent but are also masked
by interstitial edema.
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24 hours after diuretic therapy
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Chest wall lesion: arising off the chest wall and not the lung
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Pleural effusion: Note loss of left hemidiaphragm. Fluid drained
via thoracentesis
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Lung Mass
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Small Pneumothorax: LUL
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Right Middle Lobe Pneumothorax: complete lobar collapse
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Post chest tube insertion and re-expansion
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Metastatic Lung Cancer: multiple nodules seen
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Right upper lower lobe pulmonary nodule
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Tuberculosis
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Perihilar mass: Hodgkins disease
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A. Teknik pemeriksaan CT-SCAN thorax adalah teknikpemeriksaan secara radiologi untuk mendapatkan informasi
anatomis irisan crossectional atau penampang aksial
thorax.
Indikasi Pemeriksaan:
Tumor, massa
Aneurisma
Abses
Lesi pada hilus atau mediastinal
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Penggunaan media kontras dalam pemeriksaan CT-Scandiperlukan untuk menampakkan struktur-struktur anatomi
tubuh seperti pembuluh darah dan organ-organ lainnya
dapat dibedakan dengan jelas.
Teknik injeksi intravena :
Jenis media kontras : media kontras dengan osmolaritas
rendah
Volume media kontras : 80 100 ml
Injeksi rata-rata (kecepatan) : 2 ml / detik
Waktu Scan : melakukan scanning pada saat 25 detik
setelah pemasukan awal media kontras (delay).
Kasus seperti tumor dibuat foto sebelum dan sesudah pemasukan
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Kasus seperti tumor dibuat foto sebelum dan sesudah pemasukan
media kontras.
Tujuan dibuat foto sebelum dan sesudah media kontras adalah
untuk melihat apakah ada jaringan yang menyerap kontras banyak,
sedikit atau tidak sama sekali.
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Merupakan bagian paling superior dari thorax yangdisebut apeks paru-paru.
Kriteria gambar yang tampak adalah (A) vena jugularis
interna kanan, (B) arteri karotis komunis kanan, (C)Trakhea, (D) Sternum, (E) Sternoklavikula joint, (F)
klavikula, (G) Vena jugularis interna kiri, (H) arteri
subklavikula kiri, (I) arteri karotis komunis kiri, (J)
vertebra thorakal II thorakal III, (K) arteri subklavia
kanan, (L) prosesus acromion dari scapula, dan (M)
caput humerus.
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Kriteria gambar yang tampak adalah (A) vena kava
superior, (B) Aorta ascenden, (C) Corpus sternum, (D)
Window aortopulmonary, (E) oesoagus, (F) aorta
descenden, (G) vertebra thorakal IV-thorakal V, dan (H)Trakhea
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Kriteria gambar yang tampak antara lain (A) Vena kava
superior, (B) Aorta ascenden, (C) arteri pulmonari utama,
(D) Vena pulmonari kiri, (E) arteri pulmonari kiri, (F) aorta
descenden, (G) Vertebra thorakal VI-thorakal VII, (H)Vena azygos, (I) oesofagus, (J) arteri pulmonari kanan.
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Kriteria Gambar yang tampak adalah (A) Vena kava
inferior, (B) atrium kanan, (C) Katup trikuspidalis, (D)
perikardium, (E) ventrikel kanan, (F) septum
interventrikular, (G) ventrikel kiri, (H) atrium kiri, (I) aortadescenden, (J) vertebra thorakal IX-thorakal X, (K)
Oesofagus, (L) hemidiafragma kanan.
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