radiologi - pneumonia
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Stase Semicluster Radiologi-Ilmu Penyakit Dalam
RSUP. Soeradji Tirtonegoro, Klaten
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Nama : Ny. Tumini Usia : 75 tahun
No. RM : 755218
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KU : Sesak nafas dan batuk berdahak selama 1 bulan
RPS :
1BSMRS Os mengeluhkan batuk berdahak dan sesak nafas,memberat saat aktivitas (+), meringan dengan istirehat (-).Tidur menggunakan 2 bantal (-), bangun dimalam hari karenasesak (-). Sesak nafas saat dingin (-), terkena debu (-). Keduatungkai bawah membengkak (-). Demam (-), pilek (-).Berobat ke puskesmas dan diberi obat (?) membaik.
HMRS sesak nafas kambuh, os periksa ke UGD. Batuk (+),demam (-), pilek (-), perut terasa penuh (-), kaki bengkak (-).
Memberat saat aktivitas (+), meringan dengan istirehat (-).Tidur menggunakan 2 bantal (-), bangun dimalam hari karenasesak (-). Sesak nafas saat dingin (-), terkena debu (-). BAB &BAK tak ada keluhan.
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RPD
Riwayat HT (-)
Riwayat DM (-)Riwayat sakit ginjal (-)
Riwayat sakit jantung (-)
RPK
Riwayat keluhan serupa dalam keluarga
disangkal
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KU : lemah, compos mentis
Vital Sign
TD : 115/70 mmHg R : 20x/mnt
N : 80x/mnt T : 37,1 C
Kepala : CA (-/-), SI (-/-)
Leher : JVP 5+2, lnn tidak teraba
Dada-Paru
I : KG (-), retraksi kosta (+)
P : NT (-), pengembangan paru simetris, fremitus taktil ka=ki(meningkat di thorax dextra bawah)
P : sonor (+), redup pada dada kanan bawah
A: ves (+/+), RBK (+/+), RBB (+/+), wheezing (-/-)
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Dada-jantungI : IC tampak pada SIC 5 Linea axillaris anteriorP : IC teraba pada SIC 5 Linea axillaris anteriorP : cardiomegali (-)A: Suara S1 (+) reguler, S2 (+) reguler, bising (-)
AbdomenI : Dinding dada sejajar dengan dinding paruA: BU (+) 7x/mntP : timpani (+), hepatomegali (-), splenomegali (-), shifting
dullness (-)P : NT (-), hepar & lien tidak teraba
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EkstremitasEdem
WPK < 2 dtkClubbing finger (-)
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AL 17,9
AE 3,68
AT 280
Hb 11,6
MCV 89,9
MCH 29,9 MCHC 33,2
BUN 19,6
Crea 1,54
AST 65
ALT 31,2
Ureum 41,9
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Pneumonia TB
PPOK
Bronkitis Akut
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AA
AP
AaKi
VKi
Vc
A
VAz
AKa
VKa
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Chest p.a. and lateral :
The domes of the diaphragms are
evenly shaped and positioned in proper
height.
The sinuses are not obliterated.
The pleura shows no thickening.
Both lung fields have the same
transparency and no geographic or
rounded densities.
There is a harmonic bronchovascularbranching right into the periphery of the
lungs.
The upper mediastinal shadow is not
enlarged.
The tracheal band is not narrowed.
The hili are not enlarged.
There is no pathologic transformationof the cardiac silhouette.
The visualized parts of the skeleton are
normal.
The soft tissue of the chest wall is not
conspicuous.
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Chest p.a. and lateral :
The domes of the diaphragms are
evenly shaped and positioned in proper
height.
The sinuses are not obliterated.
The pleura shows no thickening.
Both lung fields have the same
transparency and no geographic or
rounded densities.
There is a harmonic bronchovascularbranching right into the periphery of the
lungs.
The upper mediastinal shadow is not
enlarged.
The tracheal band is not narrowed.
The hili are not enlarged.
There is no pathologic transformationof the cardiac silhouette.
The visualized parts of the skeleton are
normal.
The soft tissue of the chest wall is not
conspicuous.
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Chest radiograph revealingright upper lobeconsolidation.Sputum and blood cultures were positive for
Streptococcus pneumoniae.
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Right lung infiltrate (Pneumonia) Right lung infiltrate (pneumonia)progression after 2 days
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Posteroanterior chestradiograph demonstrates abilateral, relativelysymmetric distribution ofhazy ground-glass opacitiesinterspersed with areas of
coalescing alveolarconsolidation. A bilateralsymmetric distribution ofpulmonary opacities istypical of PCP (Pneumocystiscarinii pneumonia). However,
bacterial pneumonia canuncommonly mimic thisappearance.
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Bacterial pneumonia : Posteroanterior (A) and lateral (B) chestradiographs demonstrate focal consolidation in the right lower lobe,which was owing to a community-acquired bacterial pneumonia. Thepresence of focal consolidation is highly suggestive of bacterialpneumonia. Also note a small right-sided parapneumonic pleuraleffusion.
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Lobar pneumonia :Posteroanteriorchest radiographsdemonstrate lobarpneumonia of theleft lower lobe.
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Lobarpneumonia
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Bronchopneumonia
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Bronchopneumonia of the right lung
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The magnified view shows the irregular bronchovascular structures
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Chest film and magnified view of right midfield. Irregularbronchovascular markings due to recurrent inflammation withscirrous deformation
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Chest film and magnified view on the right. The lines that leave theright hilum horizontally show irregular borders because of chronicinflammation
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Chest film and magnified view from right middle/upper lung field.Irregular contours of bronchovascular structures with irregular
diameters
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Pulmonary edema on supine
view. Supine view is identified
by the absence of fundal gas
bubble below the diaphragm.
Moreover, the scapulae are
seen within the lung fields,which will not be there in a
well positioned chest X-ray PA
view. The apparent
cardiomegaly cannot be
commented upon since it is a
supine.
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When the cardiac size is normal, the possibilities to be thought of are acuteleft ventricular failure in acute myocardial infarction when the heart has not
had enough time to get enlarged and in acute fulminant myocarditis
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Lungs are large and
hyperinflated.
Signs of hyperinflation are low
set diaphragm, increased AP
diameter, vertical heart and
increased retrosternal air.Signs of hyperinflation can be
seen in emphysema, chronic
bronchitis and asthma. We
can call it emphysema only
when hyperinflation is
associated with blebs and
paucity of vascular markings
in the outer third of the film
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Lungs are large and
hyperinflated.
Signs of hyperinflation are low
set diaphragm, increased AP
diameter, vertical heart and
increased retrosternal air.
Signs of hyperinflation can be seen in
emphysema, chronic bronchitis and asthma. We
can call it emphysema only when hyperinflation isassociated with blebs and paucity of vascular
markings in the outer third of the film
Lateral chest is best to evaluate flattening ofdiaphragm, AP diameter and retrosternal air
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The presence emphysema
can be suspected on routine
chest radiography but this isnot a sensitive technique for
diagnosis. Large volume lungs
with a narrow mediastinum
and flat diaphragms are the
typical appearances of
emphysema. In addition, thepresence of bullae and
irregular distribution of the
lung vasculature may be
present. In more advanced
disease, the presence of
pulmonary hypertension maybe suspected by the
prominence of hilar
vasculature.
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The heart size is
normal. The lungs
are grosslyhyperinflated with
emphysematous
changes particularly
at the bases and
parenchymal
distortion consistentwith COPD
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Chest x-ray showing diffuse subcutaneous emphysema (black arrows) and a
right-side pneumothorax (white arrows)
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Ring shadow
Terdapat bayangan seperti
cincin dengan berbagai
ukuran (dapat mencapai
diameter 1 cm) dengan jumlah
satu atau lebih bayangancincin sehingga membentuk
gambaran honeycomb
appearance atau bounches
of grapes. Bayangan cincin
tersebut menunjukkan
kelainan yang terjadi pada
bronkus
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Tampak dilatasi bronkus yang
ditunjukkan oleh anak panah
Tampak Ring Shadow yang pada
bagian bawah paru yang
menandakan adanya dilatasi bonkus
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Ring Shadow
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Tramline shadow :Gambaran ini dapat terlihat
pada bagian perifer paru-
paru. Bayangan ini terlihat
terdiri atas dua garis
paralel yang putih dan
tebal yang dipisahkan olehdaerah berwarna hitam.
Gambaran seperti ini
sebenarnya normal
ditemukan pada daerah
parahilus. Tramline shadow
yang sebenarnya terlihatlebih tebal dan bukan pada
daerah parahilus
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Frontal chest radiographsshow diffuse cystic
bronchiectasis (arrows) in
both lungs
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Severe cystically
dilated bronchi
most marked in the
upper lung zones
bilaterally due to
cystic fibrosis
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Coloured
bronchogram of
human lung
showing
bronchiectasis
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Chest
radiograph
shows
increase
pulmonarymarkings
bronchial wall
thickening with
dilatation,
honey combing
and cystic
spaces
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A large left sided pleural
effusion as seen on an upright
chest x-ray
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Chest radiograph showing a right-sided transudative
pleural effusion
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Hemorrhagic effusion
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Pleural effusion chest x-ray. The arrow A shows fluid layering in the right
pleural cavity. The B arrow shows the normal width of the lung in the cavity
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Pleural effusion more evident on lateral view
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Chest x-ray showing bilateral air space disease, left pleural effusion,
pneumomediastinum and subcutaneous emphysema
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