LAPORAN PAGI

Abshari Ainisabila
10/304664/KU/14083

IDENTITAS
Nama : Tn. L
TTL : 03/05/1942
Alamat : Moyudan, Sleman,
Yogyakarta
No. RM : 01013xxx
Tanggal Hasil : 04/03/2015
Keterangan Klinis : CAP cr IV, CHF cf
II

Proyeksi AP
Posisi Semierect
Tampak 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 bilateral
Tak tampak pelebaran pleural
space bilateral
Tampak diafragma bilateral licin
dan tak mendatar
Cor, CTR= 0,68, tampak arcus
aorta prominent
Sistema
tulang
yang
tervisualisasi intak

Kesan
Edema pulmo disertai pneumonia
dextra
Cardiomegali dengan elongation
aorta

TEORI

PULMONARY EDEMA
Edema
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

ETIOLOGY
Cardiogenik
tekanan
hidrostatik
eg. LHF aritmia,
fluid overload
(kidney failure)
NonCardiogenik
perubahan
permeability
membran kapiler
atau tekanan
onkotik plasma

PATOFISIOLOGI
Imbalance Starlings Force
- Peningkatan tekanan kapiler paru eg.
Stenosis mitr al, LHF
- Penurunan tekanan onkotik plasma eg.
hipoalbumin
- Peningkatan tekanan negatif interstitial eg.
Asma bronkial
Kerusakan alveolar-capillary barrier
Obstruksi limpatik
Idiopathik

GAMBARAN RADIOLOGI
Cardiogenik
Kerley B lines (septal lines)
Seen at the lung bases, usually no more than 1 mm thick and 1
cm long, tegak lurus terhadap permukaan pleura
Pleural effusions
Usually bilateral, frequently the right side being larger than the
left
If unilateral, more often on the right
Fluid in the fissures
Thickening of the major or minor fissure
Peribronchial cuffing
Visualization of small doughnut-shaped rings representing fluid
in thickened bronchial walls
The heart may or may not be enlarged
When the fluid enters the alveoli themselves, the airspace
disease is typically diffuse, and there are no air bronchograms

Stage 1 Redistribution

Redistribution/cephalisation

Stage 2 Interstitial Edema

CHF 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 septa
1-2cm horizontal line near costophrenic angle. Tegak
lurus dengan pleura
Spesifik 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 Appearence

Fluid leakage tidak bisa dikompensasi oleh drainase limfatik sehingga cairan
leakage ke alveolar (alveolar edema) dan ke pleural space (efusi pleura)
Panah Biru: efusi pleura
Panah Kuning: edema alveolar dengan konsolidasi perihilar consolidations dan
air bronchograms
Panah Merah: pelebaran vascular pedicle
Kepala Panah: enlarged cardiac silhouette

GAMBARAN RADIOLOGI
Non-cardiogenic pulmonary edema
Bilateral, peripheral air space disease
with air bronchograms or central
bat-wing pattern
Kerley B lines and pleural effusions are
uncommon
Typically occurs 48 hours or more after
the initial insult
Stabilizes at around five days and may
take weeks to completely clear

Batwing/butterfly appearence
Gambaran opasitas yang menunjukkan
pattern of perihilar shadowing

TERAPI
Cardiogenic pulmonary edema
Oxygen
Diuretics
Lasix, etc.
Nitrates
Nitroglycerin, etc.
Natriuretic peptides
Nesiritide, etc.
Morphine
Inotropic agents
Dopamine, dobutamine, digoxin, etc.
Angiotensin converting enzyme (ACE) inhibitors
Beta-blockers
Carvedilol, etc.
Non-cardiogenic pulmonary edema
Treatment is supportive
Ventilator management.
Antibiotic therapy, when necessary
Corticosteroids

ELONGASIO AORTA
Menilai Elongasio Aorta
< 30 tahun : tidak dapat menilai elongasio aorta karena
jantung masih turun
> 30 tahun
jarak 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