FOTO TORAKS TB PARU

Pola penyakit :

Konsolidasi/ air-space opacity

Interstitial opacity
Nodul dan massa
Limfadenopati
Kista dan cavitas
Abnormalitas pleura

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Konsolidasi/ Air-Space Opacity

Akibat pengisian alveoli o/ : cairan, pus, darah, sel

(tumor), dll
Difus atau isolasi hingga segmentasi, atau lobular pada
paru

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Pneumonia

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

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Interstitial Opacity

Penyakit terlokalisir di interstisium pulmo, ex :

septum alveolaris dan jaringan ikat di alveoli

Tanda :

Garis dan atau retikulasi

Nodul kecil : pola milier

DDX: edema pulmo, penyakit paru interstisial

(fibrosis pulmo idiopatik), sarcoidosis, infeksi,
tumor, dll

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Interstitial Opacity: Lines

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

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Interstitial Opacity: Lines

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

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Interstitial Opacity: Lines & Reticulation

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

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Nodul dan Massa

Nodul: lesi tersendiri, batas tegas, opak, sirkular,

diameter 0.2 - 3 cm
Massa : > 3 cm
Deskripsi:

Single / multiple

Ukuran

Ciri batasnya

Ada/tidaknya kalsifikasi

Lokasi
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Well-Defined

Calcification

Ill-Defined

Mass

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

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Lymphadenopathy (LAN)

Istilah non spesifik

Pelebaran mediastinal
Penonjolan hillus

Istilah spesifik

Lokasi terutama yg membesar

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Right Paratracheal & Bilateral LAN

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

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Kista dan Kavitas

Ruang parenkim pulmonal yg abnormal

(lubang), berisi udara dan atau cairan, dinding
tegas > 1 mm.

Kista : kongenital atau didapat

Kavitas: nekrosis jaringan (inflamasi dan atau keganasan)

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TB atau bukan TB? Cysts and Cavities

A
C

45 year old man

from China with
cough, weight loss

B
D

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

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TB atau bukan TB?Cysts and Cavities (2)

Are there radiographic features that suggest
benign vs. malignant diagnoses?
Kista jinak: ketebalan dinding
seragam, 1mm, garis dalam halus
(e.g., PCP)
Kavitas jinak:
ketebalan dinding
max 4 mm, garis
dalam minimal,
ireguler (e.g., TB)
Kavitas ganas: ketebalan
dinding 16 mm, garis
dalam ireguler
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Penyakit Pleura: Pola dasar

Efusi

Sudut tumpul massive

Ketebalan

Massa

Udara

Kalsifikasi

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Pleural Effusion

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Post-TB Pleural Calcification

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Basic Radiology for the TB Clinician

Manifestasi
Radiologi TB

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Can this be TB?

Pola Tipikal:
TB Post-primer

Apikal / segmen posterior

lobus superior

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Typical pattern: Post-Primary TB

Patterns of disease

Air-space consolidation
Kavitas, nodule
Menyebar endobronchial
Miliar
Bronchostenosis
Tuberculoma
Efusi pleural
(empyema >>)

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Can this be TB?

Pola Atipikal : Primary TB

Distributsi : lobus manapun

Air-space consolidation

Kavitas jarang (<10%)

Adenopathy sering tjd (t.u. anak

dan HIV), predileksi di sisi kanan.

Pola miliar

Efusi pleura

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Can this be TB? Miliary TB

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Radiographic Patterns: Pulmonary TB

Typical
(Post-Primary)

Atypical
(Primary)

Infiltrate

85% atas

Atas : Bawah
60 : 40
>> atas pd anak

Cavitation

Sering

Jarang

Adenopathy

Jarang

Anak2 sering.
Dewasa ~30%
Unilateral > bilateral

Effusion

Dapat terjadi

Dapat terjadi

TB Pattern

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CXR Pattern: Early vs. Advanced HIV

Early HIV

Advanced HIV

(CD4>200)

(CD4<200)

Pattern

Typical
(Post-primary)

Atypical
(Primary)

Infiltrate

Lobus atas

Lobus bawah, multipel,

atau miliar

Cavitation

Sering

Jarang

Adenopathy

Jarang

Sering

Effusion

Jarang

Lebih sering
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Can this be TB?

Old / Healed TB

Ca++ granulomaGhon lesion

Ca++ granuloma and hilar node

calcificationRanke complex

Penebalan pleura apikal

Fibrosis

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TERIMA KASIH