skill pernafasan up date 2014
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PEMERIKSAAN RADIOLOGI PADA SISTEMPERNAFASAN
SKILL LABFAKULTAS KEDOKTERAN UNIVERSITAS ISLAM SULTAN
AGUNG
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Radiasi buatan berbentuk gelombang elektromagnetik berenergi tinggi, yang diperoleh dengan mengalirkan aliran listrik tegangan tinggi ke dalam tabung pesawat rontgen
Sifat sinar X:
Mempunyai daya tembus tinggi.
Menghitamkan film.
Menimbulkan ionisasi.
Menimbulkan efek biologis.
SINAR X
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1. Posisi PA
2. Simetris
3. Ketajaman cukup.
4. Inspirasi cukup.
5. Tampak sudut kostofrenikus kanan-kiri.
6. Tampak batas atas C 7.
7. Tidak goyang.
8. Marker.
9. Identitas.
SYARAT FOTO TORAK YANG BAIK
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Normal chest
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• Bandingkan kanan-kiri.
• Corakan bronkovaskuler.
• Fisura minor/mayor.
• Pleural line.
• Gambaran radioopaq/luscent
PENILAINAN PARU
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Pengurangan volume udara paru disertai volume paruyang berkurang, atau disebut juga kolaps paru.
ATELEKTASIS
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GAMBARAN RADIOLOGI
Dasar : berkurangnya airasi pengurangan volume paru peningkatan densitas bayangannya lebih suram/opaq
Pengurangan volume paru.
Peningkatan densitas (suram/opaq).
Distorsi struktur anatomi berat emfisema
kompensasi.
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Tanda langsung:
Penarikan fisura interlobaris.
Peningkatan densitas.
Tanda tak langsung:
Penarikan diafragma, hilus,
mediastinum.
Hiperinflasi kompensasi.
Penyempitan sela iga.
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Cairan yang berlebihan dalam rongga pleura.
Penyebab:
Infeksi.
Tumor.
Metastase.
Sistemik: hambatan aliran getah
bening,ginjal, penyakit hati, gagal
jantung.
Trauma.
EFUSI PLEURA
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Macam cairan pleura:
Transudat.
Eksudat.
Cairan getah bening.
Darah.
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Foto toraks PA :
Perselubungan homogen menutupi struktur paru bagian bawah, permukaan atas cekung, berjalan dari lateral atas kemedial bawah.
Jaringan paru terdorong ke sentral/hilus.
Mendorong mediastinum ke kontralateral.
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Kurang 100 cc (50–100cc): dekubitus,sinar horisontal
Kurang 250 cc (100–200cc): sinus kostofrenikus posterior padafotolateral tegak
Jumlah cairan pada foto toraks PAtegak: minimal 250– 300cc.
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Peradangan paru.
Etiologi:
- Bakteri. - Bahan kmia.
- Virus. - Lesi kanker.
- Protozoa. - Radiasi ion.
- Jamur.
PNEUMONIA
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X Foto ToraksGambaran konsolidasi radang.
Udara dalam alveoli digantikan oleh cairan dansel radang bayangan homogen densitas tinggi pada satu segmen, lobus atau segmen lobus yang berdekatan.
Beda dengan atelektasis tidak terdapat pengurangan volume.
Bercak sekitar bronkus, melibatakan alveoli bronkopneumonia.
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Airspace of the lung
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Normal lung
Individual alveoli are too small to resolve, but together they appear radiolucent.
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Dibagi menjadi 2:
1. Tuberkulosis anak
(infeksi primer).
2.Tuberkulosis sekunder
(reinfeksi).
TUBERKULOSIS PARU
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Infeksi Mycobacteriumtuberculosis
melalui jalan pernafasan (inhalasi).
Biasanya pada anak.
Lokasi bisa dimana saja.
Sering disertai pembesaran kelenjar
limfe regional.
TUBERLULOSIS PRIMER
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Gambaran Radiologi
Limfadenopati hilus dengan atau tanpa konsolidasi parenkimal
Komplek Ranke : kalsifikasi pada kelenjar limfe hilus dengan granuloma
parenkimal (focus Ghon)
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Kalsifikasi kelenjar limfe hilus dengan granuloma (Kompleks Ranke)
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Kronis, terjadi pada dewasa.
Reinfeksi pada seseorang yang dimasa kecilnya pernah menderita tuberkulosis primer.
Biasanya di lapangan atas dan segmen apikal lobus bawah.
Jarang disertai pembesarankelenjar limfe.
TUBERKULOSIS SEKUNDER
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GAMBARAN RADIOLOGIS
Kesuraman berupa bercak. Kesuraman berupa awan. Kavitas. Kalsifikasi. Fibrosis.
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EMFISEMA
Suatu keadaan dimana paru lebih banyak berisi udara, sehingga ukuran paru bertambah.
Jenis:
1. Emfisema obstruktif.
2. Emfisema non obstruktif.
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Normal vs. emphysematous lung tissue
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Gambaran foto toraks:
Kifosis (penambahan ukuran paru antero posterior).
Diafragma letak rendah (penambahan ukuran vertikal).
Bayangan lebih radioluscen.
Pendorongan mediastinum ke kontralate ral.
Sela iga melebar.
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Emphysema
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emphysema
normal
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PNEUMOTORAKS
Adanya udara dalam rongga pleura.
Dibedakan:
1. Pneumotoraks spontan.
Penyebab:
Bula yang pecah,
Trauma tertutup dinding toraks,
Fistula bronkopleural akibat neoplasma atau inflamasi.
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2. Udara lingkungan luar masuk kedalam rongga pleura.
Luka tusuk.
Pneumotoraks artifisial: pengecilan kavi tas, tindakan biposi dan pengeluaran cairan.
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3. Masuknya udara melalui mediastinum.
Disebabkan:
Trauma pada trakea atau esofagus akibat
tindakan pemeriksaan.
Benda asing tajam yang tertelan.
Keganasan mediastinum.
4. Udara berasal dari subdiafragma karena adanya robekan lambung akibat trauma atau abses subdiafragma.
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Gambaran radiologis:
Bayangan radioluscent tanpa struktur jaringan paru (avascular pattern).
Jika luas menekan jaringan paru ke arah hilus/paru menjadi kolaps ke arah hilus.
Mendorong mediastinum ke kontralateral.
Sela iga melebar.
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BRONKIEKTASIS
• Suatu keadaan bronkus atau bronkiolus melebar akibat hilangnya elastisitas din ding otot bronkus.
• Disebabkan obstruksi atau peradangan kronis, kelainan kongenital.
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Pemeriksaan X Foto Toraks:
Corakan bronkovaskuler kasar.
Garis – garis transluscen panjang me
nuju hilus, dengan bayang konsolidasi sekitarnya akibat peradangan sekun
der.
Bulatan – bulatan transluscen: gamba ran sarang tawon (honey comb appea rance)
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