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Metastase Paru

TBC Paru

KAU
Chest Radiography: Basic
Principles
X-ray
X-rayphoton:
photon:Absorbed
Absorbed//scattered
scattered//
transmitted
transmitted
X-ray
X-rayabsorption
absorptiondepends
dependson:
on:
Beam energy (constant)
Beam energy (constant)
Tissue density
Tissue density
Maximum X-Ray Blackest
Transmission air
(least dense tissue)
fat
soft tissue
calcium
bone
X-ray contrast
Maximum X-Ray metal
Absorption
(densest tissue) Whitest
Differential X-Ray
Absorption Why we see what we
see:
Structures are visible on
a radiograph because of
the juxtaposition of two
different densities

No boundary can be seen


between two structures
because they now are
similar in density

Image credit: Curry International Tuberculosis Center, University of California, San


Silhouette Sign: RLL Pneumonia
Silhouette Sign: RLL
Pneumonia

Image credit: Curry International Tuberculosis Center, University of California, San


Approach to Reading a
CXR
Be Systematic
Lungs
Pleural surfaces
Cardiomediastin
al contours
Bones and soft
tissues
Abdomen

Image credit: Curry International Tuberculosis Center, University of California, San


Worth a Second Look
Apices
Retrocardiac areas (left and
right)
Hilar regions
Below diaphragm
Frontal and Lateral Views
Heart
Aorta
Pulmonary
arteries
Image credit: Curry International Tuberculosis Center, University of California, San
Airways 22
Aortic arch
Right pulmonary
artery
Left pulmonary
artery
Trachea &
bronchi

Image credit: Curry International Tuberculosis Center, University of California, San 23


Well-Defined Calcification

Ill-Defined Mass

Image credit: Curry International Tuberculosis Center, University of California, San 32


Typical Pattern:
Post-primary TB
Distribution
Apical / posterior
segments of upper
lobes
Superior segments of
lower lobes
Typical pattern: Post-
Primary TB
Patterns of disease
Air-space consolidation
Cavitation, cavitary nodule
Endobronchial spread
Miliary
Bronchostenosis
Tuberculoma
Pleural effusions
(empyema most likely in
post-primary disease)
Atypical pattern:
Primary TB

Distribution : any lobe


involved (slight lower lobe
predominance)
Air-space consolidation
Cavitation is uncommon
(<10%)
Adenopathy is common
(esp. children and HIV),
predilection for right side
Miliary pattern
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Radiographic Patterns:
Pulmonary TB
Typical
TB Pattern (Post-Primary) Atypical
(Primary)

Upper : Lower
60 : 40
Infiltrate 85% upper Usually upper in
children

Cavitation Common Uncommon


Children common
Adults ~30%
Adenopathy Uncommon Unilateral >
bilateral
Effusion May be present May be present

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Can this be TB?
Old / Healed TB
Ca++ granulomaGhon lesion
Ca++ granuloma and hilar node
calcificationRanke complex
Apical pleural thickening
Fibrosis and volume loss

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Lung metastasis
Second most common site of metastasis (
secondary to liver )
Occur in up to 80% of patients with
sarcoma and between 2%-10% of people
with carcinoma
Symptomps are not usually present
Only 15-20% patient will complaint with
cough or haemoptisis
The presence of symptoms usually suggests
proximity of tumor to larger airways
Imaging
Initial evaluation for metastasis should be
plain films
Posteroanterior (PA) and lateral views,
should be the initial imaging test in
patients without known or suspected
thoracic metastatic disease
If foci are detected, CT imaging should be
performed
CT is useful in determining resectability
potential
MRI or PET scan have not been shown to be
as accurate or cost effective
Type of metastasis
Hematological metastasis
Cancer seeds the lung via blood stream
Forms solid nodule in the lung upon plain
films
These are commonly called cannonball
metastasis
Usually found in primary tumors from the
breast, GI tract, kidney, testes, head and
neck tumors, sarcomas
Contd
Metastases also frequently appear in multiple
sites throughout the lungs simultaneously.
Despite radiographic appearance
Multiple simultaneous lesions may need to be
differentiated from infectious processes
while single lesions need to be differentiated
from a primary lung cancer
Ultimately determining whether a new
pulmonary nodule in a patient with history of
cancer is a metastasis requires
histopathologic confirmation
Type of metastasis
Lymphatic spread
Occurs when cancer spread is via permeation
of the malignancy through lymphatic tissue
Radiologically, reticulonodular shadowing
and/or thickened septal lines maybe found
Occur secondary to dilated lymphatics and
interstitial edema
Found in tumors of the bronchus, breast,
stomach, and prostate
References
Images : Adam. Grainger & Allisons
Diagnostic Radiology. 5th Edition. 2008.
Churcill livingstone
Abelof, MD. Clinical Oncology.
Philadelpia : Elsevier. 2004
Devita, Hellman, and Rosenbergs cancer
: principles & practice of oncology.
2015.Wolters Kluwer Health