Abshari Ainisabila

LAPORAN PAGIAbshari Ainisabila10/304664/KU/14083IDENTITAS Nama: Tn. LTTL: 03/05/1942Alamat: Moyudan, Sleman, YogyakartaNo. RM: 01013xxxTanggal Hasil : 04/03/2015Keterangan Klinis : CAP cr IV, CHF cf IIProyeksi APPosisi SemierectTampak konsolidasi semiopak inhomogen di paracardial dextra, batas tidak tegas, air bronchogram (+)Tampak corakan bronchovascular meningkat dan mengabur, hilar haze (+), batwing appearence (-), cotton wool appearence (-)Tak tampak pemadatan limfonodi hilus bilateralTak tampak pelebaran pleural space bilateralTampak diafragma bilateral licin dan tak mendatarCor, CTR= 0,68, tampak arcus aorta prominentSistema tulang yang tervisualisasi intak

Kesan Edema pulmo disertai pneumonia dextraCardiomegali dengan elongation aortaTEORIPULMONARY EDEMAEdema pulmo/wet lung ialah akumulasi cairan di extravaskular jaringan paru karena perubahan tekanan hidrostatik kapiler atau peningkatan permeabilitas. Ditandai dengan dyspneu, frothy pink expectoran serous fluid, cyanosis

ETIOLOGYCardiogeniktekanan hidrostatikeg. LHF aritmia, fluid overload (kidney failure)

NonCardiogenikperubahan permeability membran kapiler atau tekanan onkotik plasma

PATOFISIOLOGI Imbalance Starlings ForcePeningkatan tekanan kapiler paru eg. Stenosis mitr al, LHFPenurunan tekanan onkotik plasma eg. hipoalbuminPeningkatan tekanan negatif interstitial eg. Asma bronkialKerusakan alveolar-capillary barrierObstruksi limpatikIdiopathik GAMBARAN RADIOLOGICardiogenikKerley B lines (septal lines)Seen at the lung bases, usually no more than 1 mm thick and 1 cm long, tegak lurus terhadap permukaan pleuraPleural effusionsUsually bilateral, frequently the right side being larger than the leftIf unilateral, more often on the rightFluid in the fissuresThickening of the major or minor fissurePeribronchial cuffingVisualization of small doughnut-shaped rings representing fluid in thickened bronchial wallsThe heart may or may not be enlargedWhen the fluid enters the alveoli themselves, the airspace disease is typically diffuse, and there are no air bronchograms

CTRBatwing appearencePeri-bronchial thickeningKerley B linesSepalisasi

Perihilar distributionAlveolar infiltrate

Collectively, the above four findings comprisepulmonary interstitial edema

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Stage 1 RedistributionRedistribution/cephalisation

Artery-to-bronchus ratioNormally the vessels in the upper lobes are smaller than the accompanying bronchus with a ratio of 0.85 (3).At the level of the hilum they are equal and in the lower lobes the arteries are larger with a ratio of 1.35.When there is redistribution of pulmonary blood flow there will be an increased artery-to-bronchus ratio in the upper and middle lobes.This is best visible in the perihilar region.On the left a patient with cardiomegaly and redistribution.The upper lobe vessels have a diameter > 3 mm (normal 1-2 mm).Notice the increased artery-to-bronchus ratio at hilar level (arrows).

14Stage 2 Interstitial EdemaCHF fluid leakage into the interlobular and peribronchial interstitium pressure in the capillaries & Kerley B lines

Kerley B line/septal line are due to fluid leakage into peripheral interlobular septa1-2cm horizontal line near costophrenic angle. Tegak lurus dengan pleuraSpesifik untuk edema pulmo terutama yang cardiogenik

Ketika cairan keluar ke peribronchovascular interstitium akan terlihat sebagai penebalan dinding bronchus (peribronchial cuffing) Gambaran vasa kabur (perihilar haze) karena di kelilingi oleh edema

Stage 3 Alveolar Edema/Cotton Wool AppearenceFluid leakage tidak bisa dikompensasi oleh drainase limfatik sehingga cairan leakage ke alveolar (alveolar edema) dan ke pleural space (efusi pleura)Panah Biru: efusi pleuraPanah Kuning: edema alveolar dengan konsolidasi perihilar consolidations dan air bronchogramsPanah Merah: pelebaran vascular pedicleKepala Panah: enlarged cardiac silhouette

Filling alveolar space w/ exudate

Hazines mulai dari hilus = butterfly appearenceSevere = patcy/cotton wool appearence18GAMBARAN RADIOLOGINon-cardiogenic pulmonary edemaBilateral, peripheral air space disease with air bronchograms or central bat-wing patternKerley B lines and pleural effusions are uncommonTypically occurs 48 hours or more after the initial insultStabilizes at around five days and may take weeks to completely clear

Batwing/butterfly appearenceGambaran opasitas yang menunjukkan pattern of perihilar shadowing

TERAPICardiogenic pulmonary edemaOxygenDiureticsLasix, etc.NitratesNitroglycerin, etc.Natriuretic peptidesNesiritide, etc.MorphineInotropic agentsDopamine, dobutamine, digoxin, etc.Angiotensin converting enzyme (ACE) inhibitorsBeta-blockersCarvedilol, etc.

Non-cardiogenic pulmonary edemaTreatment is supportiveVentilator management.Antibiotic therapy, when necessaryCorticosteroids

ELONGASIO AORTAMenilai Elongasio Aorta

< 30 tahun : tidak dapat menilai elongasio aorta karena jantung masih turun> 30 tahunjarak bagian bawah clavicula dengan arcus aorta normal = 1-2cm.elongasio aorta jika jarak < 1cm> 50 tahun- ambil garis tengah thorax- ukur lengkung aorta terjauh dengan garis tengah thorax- elongasio aorta = > 4cm

TERIMAKASIH