3. Praktikum 2 Patologi Thorax
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Transcript of 3. Praktikum 2 Patologi Thorax
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4. HamartomaOvergrowth of few tissue such as smooth muscle fibrous cartilage tissue and vascularRo :Round shadow, distinct border diameter 2,5 9 cmSoft tissue densityCalsification inside : pop corn calcification
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5. A-V Aneurysma = Pulmonary AngiomaDilatation of arterial-vein shuntFluoroscopy : Pulsating massesRo: Medial lobe, Inferior lobeVascular appearance from hilar turn to mass shadow (noduler)
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6. Pulmonary sequestration / Accesorius lobeIntralobar / extralobarOne lung segment / Group lung segment Bronchial branching separated from normal2/3 cases positioned on left postero basal segment
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6. Pulmonary sequestration / Accesorius lobeRo :Solid mass on left / right lung baseInfected / Connected with bronchus air fluid level surounded by infected lung tissue
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Large multiple noduler disorder1. Multiple metastasis tumorFrom adjacent organ:OesophagusThyroidMammaeEmboli throughPulmonary arteryBronchial artery
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Metastase in lung gave appearance ofa. Golf ball typeSarcomaRenal clear cellSeminoma
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b. Coin lesion typeThyroidGasterOvarium uterusLymphosarcomaChorio Ca
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c. Milliary typeThyroid CaMammae CaSarcomad. Pleural metastase : Pleura effusion
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e. Pneumonic typeOesophagusLungMammaef. Lymphatic typeLungGasterMammaePancreas
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2. PneumoconiosisOccupational diseasePulmonary disorder caused inhaled by foreign substanceLung reaction if invaded by foreign substanceFibrosis : SilicateNo reaction : SiderosisPneumonitis & fibrosis : Beryllium, Mangan, GasFibrosis / allergy : Cotton linen, Bagase, SugarCarcinogen : Radioactive, Asbestosis, Arsenic
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SilicosisSymptom appear after 3 yearsR :1. Lymphatic stageVascular + Lymph marking increasingHomogenous shadows in base
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2. Nodule stageNodules3. Conglomeration & Emphysematous stageNodules conglomerate
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AsbestosisDiffuse interstitial fibrosis on both lung fieldNo noduleSmall bullae or blebPleural fibrosisSiderosisSclerosing only on smaller nodule
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BerrylosisFactory worker that produce chemical used in petromax R :Like milliary tuberculosisIncreased bronchovascular markingConfluent lesion, sometimes hazy
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Small multiple nodule disorderMany, most important disorder areMilliary TBCMilliary carcinomaPneumocoliosisBronchiolitisAlveolar cell CaMilliary mycosisCont..
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SarcoidosisPulmonary amyloidosisBronchiectasy with secondary infectionInterstitial bronchopneumoniaRheumatic bronchopneumoniaPulmonary congestion
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PatchydisorderDepending on position1.Apex : Pulmonary TBC Mycosis Bronchopneumonia Loefler sindrome
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Patchy disorder 2.Medial:Oedem pulmonalBronchopneumoni 3.Basis:BronchopneumoniBronchiectasiAspirasi pneumoni
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Adult TBC1. Minimal lesionNo cavitationUnilateralAffecting apex to thoracal 4-52. Moderate lesionUnilateral / bilateralLesion rarely more than one lungLesion is solid in more than 1/3 of lungCavitation is less than 4 cm
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3. Far advance : > moderate lesion4. Chronic fibroidConstriction because of fibrosisShrinking of hemithoraxTracheal deviation / pulledHili tracted upwardShrinking of intercostal spaceTraction diaphragm / heart
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BronchopneumoniaSmall noduler, poorly defined, irregular confluentIn middle and basis (ussually)
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Pulmonary oedemaInfusion overloadRenal failure oedemaHeart failure oedemaCNS disease : cerebral tumor / post opCollagen diseaseRheumatoid arthritisPeriarthritis nodosaSclerodermaGas / fluid inhalation
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Pulmonary oedemaRoSmooth / small noduler in medialUssualy >> cor
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BronchiectasisPatophysiology a. Bronchial wall inflamation Peribronchial scarring bronchi became unelastic intraluminal pressure increase dilatation of bronchusb. Secondary inflamation on bronchus scar tissue bronchial dilatation
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Type : Cylindrical Sacculer VaricoseRo:In latter stage shows reticular shadowing/ honeycombingBronchial wall thickening
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Radioopaque disorder with increased linesLines shadow is caused by :ArteriesVeinLymphatic Bronchus
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ArteryActive hyperemi
RoStraight line shadowsDistinct borderDiameter < veinHili not enlarge
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VeinPasive hyperemi On Pulmonary congestion Decomp. CordisRoSnaking linesPoorly definedDiameter > arteryHili enlarged
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BronchusChronic infection on bronchus expand to peribronchial connective tissue fibrosis Chronic Bronchitis, PneumoconiosisPulmonary oedema, EmphysemaRoHoneycombReticular in lung base
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Lymph. vesselMediastinal node enlargementLymphoma and lymphogen metastase of malignant tumorRoStelate line shadow expanding from hilus periferEnlarged hili, kerley lines
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Cor pulmonale chronicum Lung chronic disorder that cause heart disorderEmphysema pulmonumVascular sclerosisPulmonal stenosisCongestive heart disease with left to the right shuntPulmonal fibrosis
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RoRight ventricle >Apex is upward and roundedBulging of pulmonal segment (enlargement of Pulmonary artery)Pulmonary emphysemaIncreased bronchial lines
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Pulmonary congestion on heart failure Passive hyperemiaRo:Vein dilatation Dilatation of Pulmonary artery SecondaryHili EnlargedShadowing in 2/3 medialCor >>, left > rightSometimes accomp. by pleural effusionDiaphragma elevation if accomp, by ascites / hepatomegali
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Pulmonary fibrosisFibrosis from interstitial tissue, perivascular and peribronchialOnSclerodermaLipoid storage diseaseInhalation agentRadiationDrugs : Bleomycin
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Ro:Diffuse Reticular shadows & Emphysema in base / middle fieldFlatening of costaeDiffuse radiolucencyLow position diaphragmSmall heart (tear drops)
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Pulmonary disorder with increasing radiolucencyExtrapulmonarya. Air trapped in normal space : Pneumothoraxb. Air trapped in abnormal space :Hernia diaphragmaticaSubphrenic colon interpositionDiaphramatic eventration
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Intrapulmonarya. Circumscript cavityCystAbscess
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b. Generalized1. Over distentionBall valve type obstructionEmphysema2. VascularCongestive pulmonary stenosisPulmonary emboli ( without infarction)Pulmonary arterial displasia
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Pulmonary cystSpherical cavity, thin walled, non granulomatous, filled with air / fluid
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ClassificationA. SolitaryCongenital cystInfection cystNeoplastic cyst
B. MultipleApexBlebBlulla
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BasalBronchiectasis cystPneumatocele cystUndefinedTuberculosa complicationComplication of other infiltrative processes
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Ro:Spherical cavity in all projection except in near diaphragm or chest wall.
DD:/ Encapsulated pneumothorax
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If filled full with air radioopaqueIf Ruptured to bronchus air fluid levelIf infected thick walled, loss of sharp defined
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Congenital cystOriginEmbryonal primary lobeEndoderm disorder mucosa like gasterConnected / not connected with digestive tractSolitary thin walled with fluidConnected with bronchus air fluid level
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Hydatid cyst / echinococcusCyst s Outer wall fibrous tissueWall that border daughter & granddaughter cyst hyalin tissue Filled with fluid
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RoIf ruptured ordinary cystIf ruptured separated ectocyst from adventitia tunica cyst showed with double walledRarely calcifiedCyst > 10 cm
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Bleb & BullaBulla : Vesicular emphysema area in lung tissueBleb : Interstitial emphysema that located between visceral pleura and lung tissue
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Giant Bulla Soliter, unilateral asym, lungBulla will pushes mediastinum & diaphragma DD: PneumothoraxIf very large DD: pneumothorax
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PneumatocelePure interstitial emphysemaWall from bronchial alveolus adventitia tunicaIn suppurative pneumonia
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Pulmonary emphysemaDilatation of part / whole lung that filled with excessive airClassificationa. General / Localb. Acute / Chronicc. Static / Progresive
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Acute emphysema1. Acute obstructive emphysemaObstruction : Airways ball valve obstruction2. Acute vesicular emphysemaObstruction on bronchioles because of inflamation processes in bronchioli / lungIn staphylococ pneumonia
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3. Acute interstitial emphysemaAir is forced into pulmonary interstitialIn: PertussisPenetration wound in thorax
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4. Mediastinal EmphysemaAir is entering mediastinum On Trauma : Tracheal perforation / oesophagus mediastinumIn PertussisRo : Luscent lines in mediastinum
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Chronic emphysemaEtiologi : UnknownIn : Chronic cough / people that work with wind producing instrument
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RoWidening of thorax transversal and AP diameterFlatening of costaeLung hyperlucencyInterstitial fibrotic app. Small and narrow heartEnlargement and wide vascularLateral photo shows enlargement of anterior mediastinum
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Senile emphysemaAtrophy of alveoly wall that caused chronic pulmonary emphysema because of interstitial fibrosis
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Compensatory bullous emphsemaCause : vanishing diseaseIf the process is progresive in one periode serial photoPresenting with cor pulmonalePulmonary segmen bulging, vascular, bulging and widening of hili