Download - ATELEKTASIS 2003
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Definisi Atelektasis
Keadaan alveoli paru sebagian / seluruhnya tidak terisi
udara / kolaps, akibat hambatan aliran udara yang
melewati bronkhus dan percabangannya,
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Patofisiologi Atelektasis
Sumbatan pada saluran pernafasan udara di dalam alveoli
terserap ke dalam aliran darah alveoli akan mengempis dan
memadat . Selanjutnya dapat terjadi :• Jaringan paru-paru yang mengkerut terisi dengan
sel darah, serum, lendir mengalami infeksi.
• Perfusi darah ke paru akan kekurangan O2 Hypoksemia transudasi cairan dan gas edema paru.
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Etiologi Atelektasis
1. Bronkhus yang tersumbat
2. Tekanan Ekstra Pulmonal3. Paralisis gerakan
pernapasan4. Hambatan gerakan
pernapasan
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Bronkhus yang tersumbat @ Sumbatan dalam lumen bronkhus :
Tumor Bronkhus ( Ca-Bronkhogenik ), TB Endobronkhial, benda asing, sekret kental .
@ Penekanan bronkhus dari luar lumen : Tumor di luar lumen bronkhus, Kelenjar sekitar bronkhus yang membesar.
Etiologi Atelektasis ...
........
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Tekanan Ekstra Pulmonal Pneumothoraks Efusi PleuraTumor MediastinumPeninggian diafragma ( penekanan
diafragma ke atas )Herniasi organ abdomen ke dalam rongga
thoraks
Etiologi Atelektasis ....
.......
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Paralisis gerakan pernapasan Poliomielitis ( gangguan otot–otot bantu napas )Gangguan neurologis pernapasan ( inervasi otot
napas )Gerakan napas terganggu menurunkan
kelancaran sekresi bronkhus sumbatan oleh lendir /
sekret atelektasis
Etiologi Atelektasis ...........
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Hambatan gerakan pernapasan Kelainan Pleura atau Trauma thoraks
menahan rasa sakit menurunkan gerakan paru
meng-hambat pengeluaran sekret atelektasis
Etiologi Atelektasis ...........
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Pembagian Atelektasis
Atelektasis Absorbsi : akibat sumbatan jalan napas.secara bertahap udara dalam lumen bronkhus akan di
serap oleh aliran darah paru, akibatnya makin lama alveoli
paru menjadi kempes / kolaps, sehingga volume paru pada
sisi yang tersumbat akan berkurang.Atelektasis Relaksasi : Akibat terjadinya tekanan
negatif pada cavum pleura. Misalnya pada Pneumothoraks atau Efusi pleura.
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Pembagian Atelektasis ..........
..Atelektasis Kontraktil: atelektasis akibat fibrosis pada
alveoli paru, sehingga alveoli tidak dapat terisi udara.
Atelektasis Adhesive: atelektasis akibat hilangnya Surfaktan pada dinding alveoli, sehingga tegangan permukaan alveoli tidak ada. Misalnya pada kasus ARDS / diffuse adhesive
atelectasis atau pada kasus emboli paru / plate like atelectasis
akibat hilangnya CO2 and surfactant.
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Atelektasis Bulat / Round Atelectasis : Atelektasis akibat penyakit pada pleura ( Asbestosis )
Pembagian Atelektasis ............
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Bentuk lain atelektasis
1. Sindroma Lobus Medialis2. Atelektasis Percepatan3. Mikroatelektasis tersebar /
terlokalisir
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Sindroma Lobus Medialis Atelektasis yang terjadi oleh karena lobus medius Paru kanan mengkerut, akibat penekanan bronkus Lobus
medius oleh suatu tumor atau pembesaran kelenjar getah
bening.Paru-paru yang tersumbat dan mengkerut, dapat berkembang menjadi pneumonia yang tidak dapat
sembuh total / peradangan kronis, jaringan parut dan bronkiektasis.
Bentuk lain atelektasis ..........
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Atelektasis Percepatan Biasanya terjadi pada pilot pesawat tempur. Penerbangan dengan kecepatan tinggi akan
menutup saluran pernafasan kecil, menyebabkan alveoli
menciut / mengempis.
Bentuk lain atelektasis ..........
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Mikroatelektasis tersebar / terlokalisir Akibat terganggunya sistem surfaktan paru.Surfaktan adalah zat yang melapisi alveoli dan
berfungsi me -nurunkan tegangan permukaan, sehingga
mencegah pengkerutan.Pada bayi prematur ( Sindroma gawat pernafasan )Pada Orang dewasa terjadi akibat:- terapi oksigen yang berlebihan- infeksi berat dan luas ( sepsis )- faktor lainnya yang merusak lapisan alveoli.
Bentuk lain atelektasis ..........
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Diagnose Atelektasis
- Berdasar Pemeriksaan Klinis dan Pemeriksaan Fisik
- Radiologi ( Foto Thoraks PA dan Lateral ) Tanda – tanda
“ Loss of Lung Volume “- Bronkhoskopi dan bronkhografi / CT Scan
mengetahuilokasi obstruksi / sumbatan bronkhus.
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Gejala Klinis Atelektasis
- Sesak napas- Takikardi - Sianosis - Panas tinggi ( sumbatan akibat
adanya lendir / keradangan dalam saluran napas )
- Penurunan kesadaran s/d syok ( atelektasis luas / Hipoksemia berat )
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Pemeriksaan Fisik Atelektasis
Inspeksi : Gerak napas tertinggal, ICS menyempit
( di sisi yang mengalami atelektasis )Palpasi : Gerak napas tertinggal, Fremitus
raba menurun, ICS menyempit ( di sisi atelektasis )
Perkusi : Redup atau normal , bila terjadi emphysema kompensasi ( batas mediastinum bergeser ke
sisi atelektasis ), letak diafragma di sisi
atelektasis meninggi .Auskultasi : Suara napas & Suara percakapan
menurun ( di sisi atelektasis )
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Signs of Loss of Lung Volume
1. Generalized Shift of mediastinum: The trachea and heart
gets shifted towards the atelectatic lung. Elevation of diaphragm: The diaphragm
moves up and the normal relationship between left and right side gets altered.
Drooping of shoulder. Crowding of ribs: The interspace between
the ribs is narrower compared to the opposite side.
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Signs of Loss of Lung Volume .........2. Movement of Fissures
You need a lateral view to appreciate the movement of oblique fissures. Forward movement of oblique fissure in LUL atelectasis. Backward movement in lower lobe atelectasis.
Movement of transverse fissure can be recognized in the PA film.
3. Movement of Hilum The right hilum is normally slightly lower than the
left. This relationship will change with lobar atelectasis.
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Signs of Loss of Lung Volume ..........
4. Compensatory Hyperinflation Compensatory hyperinflation as evidenced by
increased radiolucency and splaying of vessels can be seen with the normal lobe or opposite lung.
5. Alterations in Proportion of Left and Right Lung The right lung is approximately 55% and left
lung 45%. In atelectasis this apportionment will change and can be a clue to recognition of atelectasis.
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Signs of Loss of Lung Volume ............................
6. Hemithorax Asymmetry In normals, the right and left hemithorax are
equal in size. The size of the hemithorax will be asymmetrical and smaller on the side of atelectasis. In a given case, one or more of these features will alert you to the presence of atelectasis.
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Adhesive AtelectasisAlveoli are kept open by the integrity of surfactant. When there is loss of surfactant, alveoli collapse. ARDS is an example of diffuse alveolar atelectasis.Plate-like atelectasis is an example of focal loss of surfactant
Relaxation AtelectasisThe lung is held in apposition to the chest wall because of negative pressure in the pleura. When the negative pressure is lost, as in pneumothorax or pleural effusion, the lung relaxes to its atelectatic position. The atelectasis is a secondary event. The pleural problem is primary and dictates other radiological findings.
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Round AtelectasisMass like density Pleural based Base of lungs , Blunting of costophrenic angle . Pleural thickening . Pulmonary vasculature curving into the density Esophageal surgical clips.
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Atelectasis Right LungOpen Bronchus Sign / Alveolar Atelectasis/ Cornified Lung Homogenous density right hemithorax Mediastinal shift to right Right hemithorax smaller Right heart and diaphragmatic silhouette are not identifiable
Atelectasis Left Lung Homogenous density left hemithorax Mediastinal shift to the left Left hemithorax smaller Diaphragmatic and heart silhouette are not identifiable
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Sub-segmental Atelectasis Also note the posterior mediastinal mass in the left apex.
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RML AtelectasisVague density in right lower lung field (almost a normal film). Dramatic RML atelectasis in lateral view, not evident in PA view. Movement of transverse fissure. Other findings include:Azygous lobe
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Atelectasis Right Upper LobeDensity in the right upper lung field Transverse fissure pulled up Right hilum pulled up Smaller right lung Smaller right hemithorax
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Atelectasis Right Lower LobeDensity in right lower lung field Indistinct right diaphragm Right heart silhouette retained Transverse fissure moved down Right hilum moved down
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Atelectasis Right Lung Homogenous density right hemithorax Mediastinal shift to right Right hemithorax smaller Right heart and diaphragmatic silhouette are not identifiable
Atelectasis Left Lower Lobe Double density over heart Inhomogenous cardiac density Triangular retrocardiac density Left hilum pulled down Other findings include:Pneumomediastinum
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Diagnose Banding atelektasis
Abses Paru ( cavitas dengan air fluid level / multi kavitas )
Asbestosis ( penebalan pleura dan fibrosis paru, serta
pembesaran kelenjar di hilusPneumotoraks ( gambaran radiolucent yang
mengikuti paru yang kolap )Karcinoma paru ( pelebaran medistinum,
pembesaran kelenjar di hilus, elevasi diafragma, dan destruksi tulang
sekitar tumor)
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Faktor resiko atelektasis
- Pembiusan ( anestesia ) dan pembedahan- Tirah baring jangka panjang tanpa
perubahan posisi- Pernafasan dangkal- Penyakit paru-paru
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Tingkat keparahan
atelektasis Tergantung banyaknya airway yang terkena
serta kualitas sumbatan pada airway yang mengalami
obstruksi.
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Pencegahan - Atelektasis
- Setelah menjalani pembedahan, penderita harus di latih untuk bernafas dalam, batuk teratur dan kembali melakukan aktivitas seperti biasa ( secepatnya )
- Meskipun perokok memiliki resiko lebih besar, tetapi resiko ini bisa diturunkan dengan berhenti merokok dalam 6-8 minggu sebelum pembedahan.
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Pencegahan - Atelektasis ...........
- Pada kelainan dada atau keadaan neurologis yang menyebabkan pernafasan dangkal dalam jangka lama, akan lebih baik bila menggunakan alat bantu mekanis untuk membantu pernafasannya.
- Alat ini akan menghasilkan tekanan terus menerus ke paru-paru sehingga meskipun pada akhir dari suatu pernafasan, saluran pernafasan tidak dapat menciut
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Penanganan - Atelektasis
Tujuan penangananan adalah menghilangkan sumbatan
Bronkhus dan percabangannya, sehingga jaringanAlveoli paru kembali mengembang.
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Penanganan - Atelektasis .............
.Berbaring pada sisi paru yang sehat sehingga Paru yang
terkena kembali bisa mengembang.Menghilangkan penyumbatan - Dengan alat Bronkoskopi.- Latihan menarik nafas dalam. - Merontokkan dahak, dengan Fisioterapi napas /
Postural drainase - Mengatasi sumbatan oleh Tumor .
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Penanganan - Atelektasis .........
.- Pada infeksi yang bersifat menetap atau berulang,
menyulitkan atau menyebabkan perdarahan, maka bagian paru-paru yang terkena mungkin perlu diangkat ( segmentomi/ lobektomi / pneumektomi ).
- Pemberian Antibiotik ( tergantung penyebab infeksi )
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TUGAS BACA / CARI INTERNET
Gambaran radiologi Atelektasis
Di bawah ini↓↓↓
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Gambaran radiologi
Atelektasis Bowing Sign In LUL atelectasis or following resection, the
oblique fissure bows forwards in the lateral view. Bowing sign refers to this feature.
S Curve of Golden The transverse fissure is "S" shaped. The
proximal portion of the fissure is convex because the tumor mass prevents the fissure from moving towards the hilum. Whenever you see this shape to a fissure, consider a mass causing atelectasis.
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Gambaran radiologi
Atelektasis Double Lesion Sign If you encounter atelectasis of RUL and RLL
sparing RML, it is difficult to comprehend a single endobronchial lesion to account for both lesions. There has to be two independent endobronchial lesions, hence it was proposed that it is unlikely to be due to primary bronchogenic cancer. The concept is based on knowledge of anatomy.
Caution: Do not rule out lung cancer when you see this phenomenon, you just have to find an alternate explanation for the second lesion.
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Gambaran radiologi
Atelektasis Open Bronchus Sign When air bronchogram is visible in an
atelectatic lung, it implies that there is no airway obstruction. It is more a trapped lung with patent airways.
Inverted Comma Sign Do not mistake an azygous lobe to
movement of transverse fissure. Azygous lobe gives the appearance of an inverted comma.