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GAMBARAN RADIOLUSEN

PADA RADIOGRAFI
KONVENSIONAL TORAKS
PEMBIMBING: DR.TOTO KUNTORO, SP. RAD
RICHARD CHAYADI
2014-061-027
RICHARD FIRMANSYAH
2014-061-030
CL ARESTA
2014-061-031
KEPANITERAAN KLINIK ILMU RADIOLOGI
FAKULTAS KEDOKTERAN UNIVERSITAS KATOLIK INDONESIA
ATMA JAYA
RUMAH SAKIT R. SYAMSUDIN, S.H.

30 MEI 2016 2 JULI 2016

Pendahuluan
Lusen: gambaran lebih hitam daripada
seharusnya pada radiografi konvensional
Benda-benda lusen pada radiografi polos
toraks adalah udara, sehingga lusensi
pada radiografi toraks akan berhubungan
dengan udara.

Toraks
Hiperlusen

Dapat dibedakan
menjadi 4 kategori

Faktor
Teknis
Kondisi
Pulmon
er

Variasi
Anatom
is
Lainlain

Vancamp E, Vancauwenberghe T, Bellinck P, Mulkens T, Salgado R, Termote JL, et al. How to approach unilateral hyperlucency of the lung? [database on the
Internet]. 2013 [cited 2016 Jun 19]. Available from: European Society of Radiology, Web site: http://dx.doi.org/10.1594/ecr2013/C-1648

FAKTOR TEKNIS
Peningkatan transmisi x-ray
Posisi rotasi pasien
Desenterisasi lateral (posisi tuba xray lateral dari bagian tengah
pasien)
Evaluasi jarak antara ujung medial
klavikula dengan prosesus spinosus.

This PA chest image demonstrates uneven lung


density due to grid cut-off. There is a significant
clue in that the left shoulder appears darker than
the right shoulder. Importantly, this uneven
demonstration of shoulder density matches the
uneven lung density.

This patient is in an AP sitting position. The patient has a left sided


hemiplegia causing him to both lean and rotate. This technique has
resulted in an apparent uneven lung density. Note the shoulder
positions and density. Note also the elongation of the right ribs.
Fuller MJ. Causes of asymmetrical lung density. [homepage on the Internet]. 2011 [cited 2016 Jun 19]. Available from:,
Web site: http://www.wikiradiography.net/page/Causes+of+Asymmetrical+Lung+Density

VARIASI ANATOMIS

PA chest radiograph of a 62-year-old woman after


left mastectomy for breast cancer. Note the
presence of a breast shadow on the right and the
absence on the left. As a result, the left lung
appears relatively hyperlucent compared with the

A typical xray appearance of


adolescent idiopathic scoliosis.
Plymouth Hospitals. Scoliosis. [homepage on the Internet].
2012 [cited 2016 Jun 19]. Available from:, Web site:
http://pposw.co.uk/scoliosis.php

Sindrom
a Poland
Kelainan kongenital,
unilateral, tidak
terbentuknya m.
Pektoralis mayor
dan minor

Abnormalitas
terlihat saat lahir
dada yang tidak
simetris

Case courtesy of Dr Hani Al Salam, Radiopaedia.org, rID: 8905

Salah satu
penyebab klasik
dari hiperlusen
hemitoraks
unilateral

Bruno DM, Yuranga W. Poland syndrome. [homepage on the Internet]. 2016 [cited 2016 Jun 19]. Available from:, Web site: http://radiopaedia.org/articles/poland-syndrome

PULMONARY CONDITIONS
Emfisema
Asma
Aspirasi Benda Asing

Dillman JR, Sanchez R, Ladino-Torres MF, Yarram SG, Strouse PJ, Lucaya J. RadioGraphics 2011; 31:723741. Published

Knipe H, Danaher L. Pulmonary emphysema. [homepage on the Internet]. 2016 [cited 2016 Jun 19]. Available from:, Web site: http://radiopaedia.org/articles/pulmonary-emphysema

Knipe H, Danaher L. Pulmonary emphysema. [homepage on the Internet].


2016 [cited 2016 Jun 19]. Available from:, Web site:
http://radiopaedia.org/articles/pulmonary-emphysema

Jain A, Anand K, Singla S, Kumar A. Congenital cystic lung diseases. JClin


ImagingSci2013;3:5.

Chest X-ray posteroanteriorviewshows a large


hyperlucent area (red arrow) in the left upper, mid,
and lower zone with attenuated vascular markings
within the lucency (green arrow)
Unilateral hyperlucent hemithorax in an 18-year-old man with
a history of chronic lung disease associated with premature
birth and severe right lung emphysema. Posteroanterior (PA)
chest radiograph obtained at end expiration shows a markedly
hyperlucent, hyperexpanded right lung with leftward
mediastinal shift. Areas of opacification in the left upper lobe
are a result of chronic changes associated with premature

ASMA
Inflamasi
reversibel dari
jalan napas
dan obstruksi
reversibel jalan
napas akibat
hiperaktivitas.

Radiografi
konvensional
dada normal
pada 75%
pasien asma.

Penemuan
radiologis:
Hiperinflasi
pulmoner
Penebalan dinding
bronkial:peribron
chial cuffing
Edema pulmoner
(jarang)

Tatco V, Weerakkody Y. Asthma. [homepage on the Internet]. 2016 [cited 2016 Jun 19]. Available from:, Web site: http://radiopaedia.org/articles/asthma-1

Case courtesy of Townsville radiology training, Radiopaedia.org, rID: 17996

ASPIRASI BENDA ASING


Dapat
Penyebab
Benda
menganca
tersering
asing yang
Obstruksi
m jiwa,
abnormalit
tertelan
Benda
total
disertai
as
lebih sering asing yang
bronkial
gejala
intralumina
berada di
tertelan
dapat
batuk, sulit
l jalan
bronkus
lebih sering
menjadi
napas,
napas pada
primer
bersifat
atelektasis
mengi,
anak usia 6
kanan
non
pada paru
hemoptoe,
bulan
(diameter radioopak.
yang
atau
hingga 3
besar, lebih
terkena.
pneumonia
tahun.
vertikal).
rekuren.
Vancamp E, Vancauwenberghe T, Bellinck P, Mulkens T, Salgado R, Termote JL, et al. How to approach unilateral hyperlucency of the lung? [database on the
Internet]. 2013 [cited 2016 Jun 19]. Available from: European Society of Radiology, Web site: http://dx.doi.org/10.1594/ecr2013/C-1648

Courtesy of Brit B. Gay, Jr, MD, Radiology Department, Egleston


Children's Hospital, Atlanta, Ga.

Chest radiograph in a 12-month-old boy


with a 2-month history of wheezing
demonstrates
hyperlucency
and
hyperexpansion of the right hemithorax.
A corn kernel was removed from the
patient's right mainstem bronchus during
bronchoscopy.

Foreign body aspiration in a 2-year-old girl. The


initial chest radiograph shows an asymmetric
expansion of the thorax, with a right-sided
hyperaeration and shift of the mediastinum to the
left side. These findings are suggestive of an
obstructive
air trapping
process
on
the JL,right
Vancamp
E, Vancauwenberghe
T, Bellinck P, Mulkens
T, Salgado
R, Termote
et al. How to approach unilateral hyperlucency of the lung? [database on the
Internet]. 2013 [cited 2016 Jun 19]. Available from: European Society of Radiology, Web site: http://dx.doi.org/10.1594/ecr2013/C-1648
mainstem bronchus.

LAIN-LAIN

Pneumotoraks
Emfisema Subkutan

PNEUMOTORAKS

Daley BJ. Pneumothorax. [homepage on the Internet]. 2016 [cited 2016


Jun 19]. Available from:, Web site:
http://emedicine.medscape.com/article/424547-overview

Radiograph of a patient with a complete


right-sided pneumothorax due to a stab
wound.

EMFISEMA SUBKUTAN

Case courtesy of PhD Grischenkov Aleksandr, Radiopaedia.org, rID: 13767

Lee SN, Lee JH, Lee EJ, Lee JY, Kim JI, Son YB. Anesthetic course and
complications that were encountered during endoscopic thyroidectomy
-A case report-. Korean J Anesthesiol. 012; 63(4):363-7.

Intra-operative chest AP shows right pneumothorax


and subcutaneous emphysema.

Winshall JS, Weissman BN. Benign subcutaneous emphysema of the upper


extremity. N Engl J Med 2005; 352:1357.

Posteroanterior radiograph of the chest demonstrated


circumferential subcutaneous emphysema (arrows) of the
upper extremity extending from the wrist to the left
hemithorax.

Lesi Lusen
Soliter

Radiolusen Soliter
Kavitas
Inflamasi
Neoplasma
Vaskular
Lingkungan

Pneumatocele

Kavitas

Proses nekrosis
parenkim paru

Udara masuk
melalui saluran
udara
(bronkus/bronkiol
us)

Terbentuk suatu
rongga berisi
udara

Etiologi
Inflamasi

Neoplasma

Pneumonia/Ab
ses
Infeksi jamur
Tuberkulosis

Tumor paru
primer
Metastasis
(jarang soliter)

Vaskular
Rheumatoid
Infark

Lingkungan
Pneumoconiosi
s (umumnya
pada
penambang
arang atau
silikon)

Ciri-Ciri Kavitas
Inflamasi sekitar
rongga (edema,
perdarahan)

Terjadinya
nekrosis sentral,
avaskuler

Dapat
mengkompresi
parenkim paru
sekitar

Mungkin terdapat
cairan sehingga
menciptakan
gambaran air fluid
level

Contoh terjadinya nekrosis sentral


pada TB, menciptakan gambaran
air fluid level karena likuefikasi dari
parenkim paru. Di sekeliling rongga
juga terdapat fibrosis

Contoh gambaran kavitas


pada apeks paru kanan.
Pada gambaran ini
ditemukan juga gambaran
fibrosis pada sekeliling
kavitas, disertai gambaran
air bronchogram pada
apeks paru kanan, sugestif
gambaran TB paru aktif
Namun secara klinis tes
mantoux negatif. Pasien
ternyata memiliki
histoplasmosis, dimana
ciri-ciri pada radiologi
toraks menyerupai TB

Contoh gambaran
kavitas bilateral, namun
prominen terdapat pada
belakang jantung dengan
air fluid level.
Pasien ini memiliki infark
pada lobus bawah paru
kiri disebabkan oleh
Wegeners
granulomatosis

Pneumatocele
Gambaran sama dengan
kavitas
Perbedaan
Muncul pada fase penyembuhan
suatu penyakit
Bukan merupakan proses destruksi
parenkim paru
Dapat sembuh sendiri

Etiologi
Kongenital

Trauma

Aspirasi
hidrokarbon

Pneumonia
Staphylococ
cus

Gambaran pneumatocele pada pasien


post trauma.
Secara gambaran tidak memiliki
perbedaan dengan kavitas.

Kista

Suatu rongga
berdinding tipis
Dapat berisi cairan

Gambaran kista dengan air fluid


level. Dinding kista akan terlihat
lebih tipis dibandingkan dengan
kavitas atau pneumatocele.

Gambaran kista kongenital


pada neonatus. Kista
kongenital dapat memiliki
vaskularisasi sendiri, yang
disebut sekuesterasi paru
(segmentasi lobus paru
menjadi lobus lain yang
fungsinya terganggu,
sehingga lebih mudah
terjadi air trapping). Pada
foto ini, kista berukuran
sangat besar sehingga
dapat mendorong jantung
ke kiri

Hernia hiatal: Hernia melalui


lubang esofagus pada
diafragma
Hernia Morgagni dan
Bochdalek: Hernia melalui
lubang patologis pada
diafragma

Gambaran hiatal hernia. Ada gambaran rongga lusen disertai air fluid
level. Gambaran rongga berdinding tipis, sehingga mempunyai
kemiripan dengan kista. Pasien biasanya memiliki kesulitan
makan/dispepsia

Contoh hernia Morgagni. Ada


gambaran radiolusen pada
parakardial yang menyerupai
gambaran usus.

Lesi Lusen
Multipel

Kavitas Multipel

Lesi Lusen Multipel pada Pneumonia

Sumber : Reed JC. Chest Radiology Plain Film Patterns and Differential Diagnoses. 6 th ed.
Elsevier: Philadelphia. 2011.

Sumber : Reed JC. Chest Radiology Plain Film Patterns and Differential Diagnoses. 6 th ed. Elsevier:
Philadelphia. 2011.

Sumber : Reed JC. Chest Radiology Plain Film Patterns and Differential Diagnoses. 6 th ed. Elsevier: Philadelphia. 2011.

Kavitas Tuberkulosis

Sumber : Reed JC. Chest Radiology Plain Film Patterns and Differential Diagnoses. 6 th ed. Elsevier:
Philadelphia. 2011.

Septic Emboli

Sumber : Reed JC. Chest Radiology Plain Film Patterns and Differential Diagnoses. 6 th ed. Elsevier:
Philadelphia. 2011.

Neoplasma

Neoplasma

Sumber : Reed JC. Chest Radiology Plain Film Patterns and Differential Diagnoses. 6 th ed.
Elsevier: Philadelphia. 2011.

Bronkiektasis Kistik

Bronkiektasis Kistik
Penyebab tersering

Bronkiektasis Kistik

Sumber : Reed JC. Chest Radiology Plain Film Patterns and Differential Diagnoses. 6 th ed. Elsevier:
Philadelphia. 2011.

Bronkiektasis Kistik

Sumber : Reed JC. Chest Radiology Plain Film Patterns and Differential Diagnoses. 6 th ed. Elsevier:
Philadelphia. 2011.

Pneumatoceles

Sumber : Reed JC. Chest Radiology Plain Film Patterns and Differential Diagnoses. 6 th ed.
Elsevier: Philadelphia. 2011.

KESIMPULA
N

Toraks HiperlusenFaktor
Teknis

Lainlain

Toraks
Hiperlus
en

Kondisi
Pulmon
er

Variasi
Anato
mis

Lesi Lusen Soliter Kavitas

Hernia
hiatal

Lesi
lusen
soliter

Kista

Pneuma
-tocele

Lesi Lusen Multipel

Abses

Metastasi
s

Bronkiekt
asis Kistik

Lesi
Lusen
Multip
el

Septic
emboli

Tuberkulo
sis

Daftar Pustaka
Vancamp E, Vancauwenberghe T, Bellinck P, Mulkens T, Salgado R, Termote JL, et al.
How to approach unilateral hyperlucency of the lung? [database on the Internet].
2013 [cited 2016 Jun 19]. Available from: European Society of Radiology, Web site:
http://dx.doi.org/10.1594/ecr2013/C-1648
Fuller MJ. Causes of asymmetrical lung density. [homepage on the Internet]. 2011
[cited 2016 Jun 19]. Available from:, Web site:
http://www.wikiradiography.net/page/Causes+of+Asymmetrical+Lung+Density
Plymouth Hospitals. Scoliosis. [homepage on the Internet]. 2012 [cited 2016 Jun 19].
Available from:, Web site: http://pposw.co.uk/scoliosis.php
Bruno DM, Yuranga W. Poland syndrome. [homepage on the Internet]. 2016 [cited
2016 Jun 19]. Available from:, Web site: http://radiopaedia.org/articles/polandsyndrome
Dillman JR, Sanchez R, Ladino-Torres MF, Yarram SG, Strouse PJ, Lucaya J.
RadioGraphics 2011; 31:723741. Published online: 10.1148/rg.313105132
Knipe H, Danaher L. Pulmonary emphysema. [homepage on the Internet]. 2016 [cited
2016 Jun 19]. Available from:, Web site: http://radiopaedia.org/articles/pulmonaryemphysema

Daftar Pustaka
Daley BJ. Pneumothorax. [homepage on the Internet]. 2016 [cited 2016 Jun 19].
Available from:, Web site: http://emedicine.medscape.com/article/424547-overview
Jain A, Anand K, Singla S, Kumar A. Congenital cystic lung diseases. JClin ImagingSci
2013;3:5.
Tatco V, Weerakkody Y. Asthma. [homepage on the Internet]. 2016 [cited 2016 Jun
19]. Available from:, Web site: http://radiopaedia.org/articles/asthma-1
Courtesy of Brit B. Gay, Jr, MD, Radiology Department, Egleston Children's Hospital,
Atlanta, Ga.
Lee SN, Lee JH, Lee EJ, Lee JY, Kim JI, Son YB. Anesthetic course and complications
that were encountered during endoscopic thyroidectomy -A case report-. Korean J
Anesthesiol. 012; 63(4):363-7.
Winshall JS, Weissman BN. Benign subcutaneous emphysema of the upper extremity.
N Engl J Med 2005; 352:1357.
Reed JC. Chest Radiology Plain Film Patterns and Differential Diagnoses. 6th ed.
Elsevier: Philadelphia. 2011.