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Praktikum 1 Patologi Thorax
Praktikum 1 Patologi Thorax
Content
I. Disorder of A. Diaphragm B. Pleura C. Thoracic wall II. Lung parenchym disorder A. Radiopaque disorder 1. Diffuse 2.Patchy 3. Noduler 4. Linear B. Radioluscent disorder 1. Local 2. Diffuse
Diaphragm abnormality
1. Abnormality in function - Fixation / immobility
* Phrenicus nerve paralysis * Pleuritis * Subdiaphragm abcess Relative immobility COPD Paradoxal movement - Inspiratory Phrenicus nerve paralyse - Expiratory
2. Abnormality in position - Bilateral elevation - Ascites - Obesity - Pregnancy - Unilateral elevation - Gastric or colonic distention
- Decrease in size of hemithorax - Liver or splenic enlargement - Bilateral low position of diaphragm - COPD - Asthenic type - Bilateral Pneumothorax - Unilateral low position of diapraghm - Unilateral check valve obstruction of
bronchus
3. Abnormality in shape Scalloping / tenting - Normal variation - Diaphragm tumor - Pleural tumor - Subdiaphragm tumor - Subpulmonary tumor
4. Abnormality in integrity a. Congenital - Diaphragm muscle abnormality eventration - Diaphragmatic hernia b. Diaphragmatic rupture - Trauma
5. Abnormality in density - Calcification of diaphragm - Free air in diaphragmatic muscle interstitial emphysema of thoracic wall
6. Abnormality in number (Accessory diaphragm) - Rare Second leaf of right diaphragm separating right inferior lobe R - Left diaphragm elevation - Depression / thickening of major fissure - Retrosternal : triangular shape opaque shadow - Sometimes accompanied by pulmonary hypoplasia
THE PLEURA
1. Abnormality of shape, position, size Widening of pleural cavity
- Pneumothorax - Hydrothorax - Chylothorax - Emphyema - Neoplasm
2. Abnormality in density a. Increased density (opaque) - Neoplasm / pleural tumor - Calcification / fibrosis - Hydrothorax
b. Diminished density ( lucent) - Pneumothorax
Mesotelioma
Pneumothorax
Etiologies -Traumatic - Spontaneus - Theurapeutic Expiratory stand :for small pneumothorax
Pleural tumor
Benign Lipoma - Fibroma - Angioma Malignant - Mesothelioma - Sarcoma Mesothelioma : from the endothelial pleura layer
Pleural tumor
Benign Lipoma - Fibroma - Angioma Malignant - Mesothelioma - Sarcoma Mesothelioma : from mesothelial layer
Pleural tumor
2 type Noduler : > often Diffuse effusion
Metastase : From bronchogenic Ca From Mammae From Lymphosarcoma
b. Shrinking of hemithorax Whole lung atelectasis Pleural / lung fibrosis N. phrenicus paralysis Lung hipogenesis / hipoplasia
c. Thoracic cage asimetric One side of hemithorax is shrinking while the other side is enlarging Atelectasis + compensatoir emphysema
d. Congenital disorder
Achondroplasia : Short costae, thick, flat Thanata phoric dwarfism Cleidocranial dysostosis Osteogenesis imperfecta Multiple fracture Barrel chest Cont..
d. Congenital disorder
1. a.
b.
Thoracic wall density disorder Deminishing density Generalized osteophorosis / osteolysis Osteogenesis imperfecta Hyperparathyroid Hypovitaminosis C & D Achondroplasia / Thanatoporic
II. Lung parenchymal disorder A. Radio opaque disorder 1. Diffuse homogen 2. Patchy 3. Noduler 4. Linear
B. Radio lucent disorder 1. Generalized 2. Local
a. b. c. d. e. f. g.
Pulmonary atelectasis Pneumonia Epituberculosa Lung infarct Lung squester. Pleura effusion. Tumor
Atelectasis
Atelectasis Ro : Primary Sign Fissural shift Hypoaeration radio opaque Crowded of bronchovascular marking
Secondary sign
Compensatory effect to pulmonary
collaps Diaphragm elevation Mediastinal shift Hilar transposition Compensatory emphysema
Atelectasis classification Generalized atelectasis Radioopaque shadow covering the whole left/right lung Tracheal / Mediastinal pulling Compensatory emphysema Herniation
Lobar atelectasis
Superior lobe
Hilus pulled upward Trachea pulled Wedging with apex in hilus
Medial lobe
Traction of the heart , hazy border Triangular shaped shadow beside the heart
Inferior lobe
Inferior lobe twisted pulled downward, medially backward Traction of the major fisure
Lobulus atelectasis
Fleischner line ( Diag < moveable) post op
Neonatal atelectasis
HMD Segmental atelectasis
Pneumonia
Lung parenchymal inflamation that radiologicaly shows a consolidation process affecting segmen / lobus in lung
Classification
Morphologi : Lobar, lobuler Etiology : virus, bacterial
Viral pneumonia
Ro Reticulo noduler appearance in both lung field Patchy Generalised consolidation process
Bacterial pneumonia
Pneumococ pneumonia Usually lobar consolidation basal Pleural effusion rare
Staphylococ pneumonia
Usually affecting children / baby / elderly Superinfection with influenza Often with pleural effusion + cavitation
Friedlander pneumonia
Usually on elderly Usually lobar consolidation mostly right and top Accompanied by cavitation Clinical appearance severe
Epituberculosa
Non specific reaction from lung tissue around primary tuberculosa lesion
Pulmonary TBC
TBC on paediatric TBC on adult
Infection by
Oral Inhalation
Pulmonary infarction
Etiology Tumor Pneumothorax Atelectasis Vein obstruction Disturbance of pulmonal drainage Chronic cardiovascular disease
Ro (cont..)
If emboli without infarction, the affected
area ussualy appear more lucent because of the ischaemic area perifer to the emboli Enlarged heart Sometimes accompanied by Pulmonary hipertension Radiological appearanced ussually disappear in 4-7 days
DD 1. Caverne TBC Irregular cavity, distinct border with TBC lesion around them Mostly in apex
2. Cavity in malignancy Thick wall, irregular border
a. Bronchogenic Ca
Classified into : a. Central type b. Perifer noduler c. Pneumonic type d. Miliar type
b. Pancoast tumor In apex sulcus posterior medius Posterior costae 1- 3 destruction with vertebral
erosion Cervicalis symphatis paralysis Horner syndrome
3. Alveolar Ca = Pulmonary adenomatosis Female = Male 40 years Ro: Small nodule on both lung field with large
masses in pulmonary base No visible node enlargement but shows nodal consolidation in perihiler Pleura ussualy not affected Heart normal