Radiologi

23 September 2019
 RS AU ESNAWAN ANTARIKSA
• Karina Maharati Wibowo
• Meylan Fitriyani
• Wiramukti Wiramukti
• Nita Irawan Anugerah Pratama
• Iin Sakinah Dewi Mulyadi
 Pneumothoraks
• Spontaneous pneumothorax is
relatively common in theb
community.1 The incidence of
iatrogenic pneumo- thorax is
difficult to assess but is probably
increasing due to the more
widespread use of mechanical
ventila- tion and interventional
procedures such as central line
placement and lung biopsy.
Pneumothoraks
• The radiographic diagnosis of
pneumothorax is usually
straightforward (fig 1). A visceral
pleural line is seen without distal
lung markings. Lateral or decubitus
views are recommended for
equivocal cases.2 On standard
lateral views a visceral pleural line
may be seen in the retrosternal
position or overlying the vertebrae,
parallel to the chest wall.3
 Pneumothoraks
• In the supine patient, air in the
pleural space will usually be
most readily visible at the lung
bases (fig 2) in the cardiophrenic
recess and may enlarge the
costophrenic angle (the deep
sulcus sign)
 Pneumothoraks
• The chest radiograph should also be carefully exam- ined for evidence
of underlying parenchymal lung disease (fig 5). The most common of
these predisposing to pneumothorax are emphysema, pulmonary
fibrosis of any cause, cystic fibrosis, aggressive or cavitating
pneumonia, and cystic interstitial lung diseases such as Langerhans’
cell histiocytosis and lymphangiomyomatosis.
Bronkiektasie
• Bronchiectasis is permanent
irreversible dilatation of the
airways and occurs in a variety of
pathologic processes. Recurrent
infection and inflammation and
the resulting chemical and
cellular.
 Bronkiektasie
• The main clinical manifestation of
bronchiectasis is chronic
productive cough (1). Damage to
the epithelial cilia and mucosal
glands and the unfavorable
geometry of the dilated bronchus
cause each cough to be less
effective, leading to ineffective
clearance of secretions and chronic
or recurrent infections (2). These
processes can be associated with
nonspecific symptoms, including
general malaise, weight loss, and
not uncommonly, hemoptysis.
 Bronkiektasie
• The molecular pathophysiologic features of bronchiectasis are complex (Movie 2). The
airway dilates in response to an ongoing inflammatory process, causing damage to the
airway wall (16). A deleterious cytokine cascade occurs, with recruitment and stimulation
of immune cells. Of note, neutrophils release elastases, proteases, and free radicals,
which lead to airway damage (17). Initially, inflammation occurs with damage to the
epithelium and destruction of elastin in the bronchial walls that eventually progresses to
loss of the muscle and cartilage. Elevated intraluminal pressures, caused by the dual
insults of chronic cough and airway obstruction, amplify bronchial remodeling, which
leads to progressive bronchial enlargement (Movie 3). Increased mucus secretion,
decreased mucociliary clearance, airway wall thickening, and transient collapse of
weakened dilated airways may contribute to the chronic obstruction that characterizes
bronchiectasis; enlarged subepithelial lymph follicles or peribronchial and hilar lymph
nodes with resulting bronchial narrowing may also contribute to the obstruction (1,18).
In fibrosing interstitial lung diseases, external traction on bronchi is thought to play a role
in bronchial dilatation, with increased outward elastic recoil of the lungs and
corresponding negative transpleural pressures reinforcing this process (19)
 Bronkiektasie
• Chest radiography is relatively insensitive
for detection of bronchiectasis (20). In
moderate to severe cases, a “tram-track”
appearance of parallel and ringlike
opacities related to the t hickened walls
of dilated bronchi and tubular densities
related to mucus-filled dilated airways
can be seen at chest radiography (20) (Fig
1); however, many cases of bronchiectasis
are difficult to appreciate with chest
radiography. Thin-section CT is more
sensitive than chest radiography and is
the reference standard in identification
and characterization of bronchiectasis
(21).
 Lung Mass
• A solitary pulmonary nodule is
defined as a discrete, well-
marginated, rounded opacity
less than or equal to 3 cm in
diameter that is completely
surrounded by lung parenchyma,
does not touch the hilum or
mediastinum, and is not
associated with adenopathy,
atelectasis, or pleural effusion.
Lung Mass
• Benign lung tumors are a
heterogenous group of neoplastic
lesions originating from pulmonary
structures. These tumors include
bronchial adenomas, hamartomas,
and a group of uncommon
neoplasms (eg, chondromas,
fibromas, lipomas, leiomyomas,
hemangiomas, teratomas,
pseudolymphomas,
endometrioma, and bronchial
glomus tumors).
 Lung Mass
• CharacteristicsNeoplastic lesions
are characterized by the
autonomous proliferation of
cells without a response to the
normal control mechanisms
governing cell growth. An
additional characteristic of
benign tumors is extension
without local tissue invasion or
spread to other sites.
 Lung Mass
• Several radiologic characteristics found on CT scanning and
radiography (although CT scanning is superior) may help to establish
the diagnosis or suggest whether a lesion is benign or malignant.
These include the following:- Size- Growth rate- Presence of
calcification- Border characteristics- Internal characteristics- Location
Pneumonia
• Pneumonia can be generally defined as an
infection of the lung parenchyma, in which
consolidation of the affected part and a filling of
the alveolar air spaces with exudate, inflammatory
cells, and fibrin is characteristic. [4] Infection by
bacteria or viruses is the most common cause,
although infection by other micro-orgamisms such
as rickettsiae, fungi and yeasts, and mycobacteria
may occur.
• The causes for the development of pneumonia are
extrinsic or intrinsic, and various bacterial causes
are noted. Extrinsic factors include exposure to a
causative agent, exposure to pulmonary irritants,
or direct pulmonary injury. Intrinsic factors are
related to the host. Loss of protective upper airway
reflexes allows aspiration of contents from the
upper airways into the lung. Various causes for this
loss include altered mental status due to
intoxication and other metabolic states and
neurologic causes, such as stroke and endotracheal
intubation
 Pneumonia
• Thus, during pulmonary infection, acute
inflammation results in the migration of
neutrophils out of capillaries and into the
air spaces, forming a marginated pool of
neutrophils that is ready to respond when
needed. These neutrophils phagocytize
microbes and kill them with reactive
oxygen species, antimicrobial proteins,
and degradative enzymes. They also
extrude a chromatin meshwork
containing antimicrobial proteins that
trap and kill extracellular bacteria, known
as neutrophil extracellular traps (NETs).
Various membrane receptors and ligands
are involved in the complex interaction
between microbes, cells of the lung
parenchyma, and immune defense cells.
 Pneumonia
• Pneumonia due to adenovirus in a
20-year-old man with fever, cough,
and dyspnea. (a) Initial chest
radiograph shows ill-defined patchy
consolidation and GGO (arrows) in
the left middle to lower lungs and
the right lower lung zone. (b, c)
Axial chest CT images (5-mm
thickness) obtained on the same
day at the interlobar bronchi level
(b)and the inferior pulmonary vein
level (c) show ill-defined patchy
GGO (arrowheads) and lobar
consolidations (arrows).