INTERPRETASI DASAR FOTO THORAKS

BASUKI RACHMAT ICU Anak PJN HK Jakarta

PURPOSES
Interpret any structures inside of thorax cavity Interpret of bone and soft tissue of the chest Interpret any devices in the thorax cavity

PROJECTION VIEW

Posterior-Anterior (PA):
Standard view & most reliable technique

Erect films detect air under the diaphragm

Lateral view:
Done at the same time as the PA film Helps localize infiltrates For specific purposes

Anterior-posterior (AP):
Portable- patient is too ill to go to X-ray, usually patient is sitting upright in bed Poor quality but may be the best you can do Remember- AP films may cause the mediastinum & heart to appear larger than they are

Standard Radiographic Positions PA View

Standard Radiographic Positions AP View

DENSITY
How deep of structures to absorp the x rays Gas low density radiolucent black in film structures with air inside airway, lung Water more bright than gas radioopaque white muscle, blood, vasculer Fat more bright fat layer in the heart or lung Bone high density more radioopaque vertebrae, ribs, coin, marker of any devices

Five Radiographic Opacities

Air Fat Soft tissue Bone Metal

least opaque most lucent Black

to to to

most opaque least lucent White

RULES FOR BASIC INTERPRETATION

READ THE LABEL ON THE SYSTEMATIC CHEST FILM APPROACH ASSESS THE QUALITY OF IDENTITY PROJECTION VIEW THE FILM CHECK THE STRUCTURES SIDE MARKER LOOK AT THE HEART AND CONTRAST OR MAJOR VESSELS BRIGHTNESS ASSESS THE AIRWAYS SYMETRICALLY ASSESS THE LUNG TISSUES ONE BY ONE STRUCTURES LOOK FOR LINE & TUBE PLACEMENT

CXR Interpretation
Have a system!!
Method 1:
Outside-to-inside Soft tissues Bony framework Lungs & hila Diaphragm & pleura Mediastinum & heart

Method 2:
Are There Many Lung Lesions? Abdomen & diaphragm Thorax Mediastinum & heart Lung (single) Lungs (both)

CXR Interpretation
Have a system!!
T

Method 1:
Outside-to-inside Soft tissues Bony framework Lungs & hila Diaphragm & pleura Mediastinum & heart

Method 2:
Are There Many Lung Lesions? Abdomen & diaphragm Thorax Mediastinum & heart Lung (single) Lungs (both)

Normal Thoracic Anatomy

Normal CXR

NORMAL AP VIEW
Simetris Iga Posterior : 8-10 Iga Anterior : 6-8 Diafragma Flat Vaskularisasi paru terlihat

CXR Interpretation
Normal structures visible A. B. C. D. E. F. G. H. I. Costophrenic angle Diaphragm Heart Aortic arch Trachea Hilum Main carina Stomach bubble Ascending aorta

CXR Interpretation
Normal structures visible

A. B. C. D. E. F. G. H. I.

Costophrenic angle Diaphragm Heart Aortic arch Trachea Hilum Main carina Stomach bubble Ascending aorta

JANTUNG

CTR (Cardio Thorasic Ratio)

M

a b

CTR = a + b x 100% c N = < 50%

c

Dextrocardi

SNOWMAN
Gambaran Seperti boneka salju, VCS besar, Segmen Po dilatasi Terjadi pada peningkatan volume jantung kanan Contoh : Anomali total drainase vena pulmonal

BOOT SHAPE
Gambaran seperti sepatu boot, segmen pulmonal lebih cekung Terjadi karena penurunan aliran darah pulmonal Co : ToF, PS

EGG SHAPE
Gambaran seperti telur, batas kanan jantung membesar, apeks terangkat. Terjadi karena peningkatan beban jantung kanan Co : TGA

PARU

PLEURAL EFFUSION
Gambaran Radiologis : - Ada batas pleura, gambaran pemb. darah paru suram atau hilang - Sudut costoprenikus suram atau hilang

PLEURAL EFFUSION
Gambaran Radiologis : - Ada batas cairan yg horizontal - Sudut costoprenikus suram atau hilang - Pada efusi masif yg mengenai satu paru akan mendorong struktur mediastinum ke sisi yg berlawanan

ARDS
Gambaran Radiologis : - Radioopasiti yg difus diseluruh lapangan paru - Cephalisasi pembuluh darah paru - Bisa diikuti udem paru dan efusi pleura

PULMONARY EDEMA
Gambaran Radiologis : - Cephalisasi - Pelebaran hilus tanda Bat-Wings - Peningkatan Opasitas lapangan paru - Bisa diikuti atau tidak dengan pembesaran jantung

Pulmonary Edema

PNEUMOTHORAX
Gambaran Radiologis : Hiperlusensi paru Ada batas tegas pleura Tidak ada vaskularisasi paru sebelah lateral dari batas - Diafragma pada sisi yg sakit terdorong kebawah

TENSION PNEUMOTHORAX
Gambaran Radiologis : - Area hiperlusensi yg luas paru tampak kolaps - Trachea dan mediastinum terdorong kesisi yg berlawanan

ATELEKTASIS
Gambaran Radiologis : - Area opaq di lapangan paru - bisa mengenai satu segmen, lobus atau satu lapangan paru - Trachea dan mediastinum tertarik kesisi yg sakit - Sela iga pada bagian yg kolaps lebih sempit

ATELEKTASIS

FIBROSIS PARU

Gambaran Radiologis : -Paru kolaps peningkatan opasitas di lapangan paru - Vaskularisasi hilang - Trachea tertarik kesisi yg sakit

EMFISEMA SUBCUTIS
Udara di bawah kulit densitas gas di jarg lunak diluar rongga thoraks

TB MILIER
Gambaran Radiologis : - Daerah hilus yang melebar dan meluas keseluruh lapangan paru - Peningkatan opasitas dilapangan paru .

LINES AND TUBE ON CXR

Lines & Tubes on CXR

ETT : Sela iga 2 3, diatas arkus aorta, tepat dipertemuan klavikula dengan sternum SG kateter : Sela iga ke 5-6, Tips kateter terletak di 1/3 hemithoraks

IABP
Tips IABP terletak di bawah arkus aorta

False Route CV Line

PERMANENT PACEMAKER

ANEURYSMA AORTA
Pelebaran mediastinum daerah arkus aorta

Matur Nuwun

THANK YOU