Interpretasi Foto Dada

8/12/2019 Interpretasi Foto Dada

1/137

RIZKI ALIANA AGUSTINA

Ski l l Lab


2/137

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.


3/137


4/137


5/137

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


6/137

Portable (AP or Antero-posterior) PA (Postero-anterior)


7/137


8/137

PA AP


9/137

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.


10/137


11/137


12/137

Bony Framework

Soft Tissues

Lung Fields and Hila

Diaphragm and Pleural Spaces

Mediastinum and Heart

Abdomen and Neck


13/137

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


14/137

Lateral View:

1. Oblique fissure

2. Horizontal fissure3. Thoracic spine and

retrocardiac space

4. Retrosternal space


15/137


16/137

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


17/137


18/137


19/137

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.


20/137


21/137


22/137


23/137


24/137


25/137


26/137


27/137


28/137

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


29/137

Post border:

Left ventricle.

Ant border:

Right ventricle.


30/137

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.


31/137


32/137

Liquid density Increased air density

Generalized Localized

Diffuse alveolar

Diffuse interstitialMixed

Vascular

Infiltrate

Consolidation

CavitationMass

Congestion

Atelectasis

Localized airway obstruction

Diffuse airway obstructionEmphysema

Bulla


33/137

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


34/137


35/137

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


36/137

Qualifiers: single or multiple

size border definition

presence or absence of calcification

location


37/137

NODULES

MASSES


38/137

MASSES


39/137

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


40/137

Benign Lung Cyst : PCPPneumatocele

Uniform wall thickness

1 mmSmooth inner lining


41/137

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 :


42/137

Benign Cavities :

Cryptococcus

max wall thickness 4 mm

minimally irregular inner lining

Benign Cavities :


43/137

Benign Cavities :

Cryptococcus

max wall thickness 4 mm

minimally irregular inner lining

Indeterminate Cavities


44/137

Indeterminate Cavities

max wall thickness 5-15 mm

mildly irregular inner lining


45/137


46/137

Alveolar space filledwith inflammatoryexudate

WBC, bacteria,plasma, and debris


47/137

Increased heart size:cardiothoracic ratio>0.5

Large hila with

indistinctmarkings

Fluid in

interlobarfissures

Pleural effusions,

alveolar edema


48/137

Congestion Interstitial and

alveolar edema Collapsed or

distended alveoli

Bilateral


49/137

No ventilation to lobebeyond the obstruction

Trapped air absorbed by

pulmonary circulation Segmental/lobar density Compensatory hyper-

inflation of normal lungs.

TUBERKULOSIS


50/137

kuliah terpadu

TUBERKULOSIS


51/137


52/137

P th k


53/137

Pneumothoraks


54/137


55/137


56/137


57/137


58/137

Fungus ball


59/137

Pneumonia lobaris


60/137


61/137


62/137


63/137

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


64/137


65/137


66/137

LUL Atelectasis: Loss of heart borders/silhouetting. Notice

over inflation on unaffected lung


67/137


68/137


69/137

Right Middle and Left Upper Lobe Pneumonia


70/137


71/137


72/137

Cavitation:cystic changes in the area of consolidation due to the

bacterial destruction of lung tissue. Notice air fluid level.


73/137

Cavitation


74/137


75/137


76/137

Tuberculosis


77/137


78/137


79/137

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.


80/137

Chronic emphysema effect on the lungs


81/137


82/137


83/137

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.


84/137


85/137


86/137

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


87/137


88/137


89/137

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.


90/137

24 hours after diuretic therapy


91/137


92/137


93/137

Chest wall lesion: arising off the chest wall and not the lung


94/137


95/137


96/137

Pleural effusion: Note loss of left hemidiaphragm. Fluid drained

via thoracentesis


97/137


98/137


99/137

Lung Mass


100/137


101/137


102/137

Small Pneumothorax: LUL


103/137


104/137


105/137

Right Middle Lobe Pneumothorax: complete lobar collapse


106/137

Post chest tube insertion and re-expansion


107/137


108/137


109/137

Metastatic Lung Cancer: multiple nodules seen


110/137


111/137


112/137

Right upper lower lobe pulmonary nodule


113/137


114/137


115/137

Tuberculosis


116/137


117/137


118/137

Perihilar mass: Hodgkins disease


119/137


120/137


121/137


122/137

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


123/137

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


124/137

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.


125/137

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.


126/137


127/137


128/137


129/137

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


130/137


131/137

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.


132/137


133/137

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.


134/137


135/137


136/137


137/137

Interpretasi Foto Dada

Documents

Transcript of Interpretasi Foto Dada