CHEST RADIOGRAPHIC FINDINGS IN PULMONARY TUBERCULOSIS AND PNEUMONIA"The title is less than 40 characters long and starts with "TITLE

JOURNAL READING
TUBERCULOSIS
FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI

KEPANITERAAN KLINIK ILMU RADIOLOGI
RUMAH SAKIT PUSAT TNI ANGKATAN UDARA
1
2
Tuberculosis (TB) continues to be one of the greatest challenges
to global health. In 2015, 10.4 million people were estimated to
have developed TB and 1.4 million died of the disease.
World Health Organization. Global tuberculosis report 2016

3
Prompt diagnosis of TB is essential for community public
infection control and for ensuring the appropriate therapy.
Mycobacterium tuberculosis culture from specimen is the
cornerstone of diagnosis, but mycobacterial culture take
considerable time (2 to 6 weeks) to produce results,
World Health Organization. Early detection of tuberculosis: an

overview of approaches, guidelines and tools
4
M. tuberculosis is transmitted from person to person by droplet
nuclei containing the organism and spread mainly by coughing.
5
Risk factors for progressive primary disease include
immunosuppression (especially HIV infection), extremes of age,
or a large inoculation of mycobacteria. However, in most infected
individuals, TB remains clinically and microbiologically latent for
many years. This condition, known as latent TB infection, may be
detectable only by a positive tuberculin skin test or interferon γ
release assay result, or by the presence of radiologically
identifiable calcification at the site of primary lung infection or in
regional lymph nodes.
Jeong YJ, Lee KS, Yim JJ, Jeong YJ, Lee KS, Yim JJ. The diagnosis of
pulmonary tuberculosis: a Korean perspective. Precision and Future
Medicine. 2017 Jun 30;1(2):77-87. 6
Chest radiographs play an important role in the screening and
diagnosis of pulmonary TB. The typical radiographic findings of
pulmonary TB in immunocompetent hosts consist of focal or
patchy heterogeneous consolidation involving the apical and
posterior segments of upper lobes and the superior segments of
lower lobes (Fig. 2)
Medicine. 2017 Jun 30;1(2):77-87. 7
Another common finding includes
poorly defined nodules and linear
opacities. Single or multiple
cavities are radiographically
evident in 20% to 45% of patients
Medicine. 2017 Jun 30;1(2):77-87. 8
However, radiographs may be normal or show only mild or
nonspecific findings in patients with active disease. Actually,
initial radiographic diagnoses of TB are correct in only 49% of
cases.
Medicine. 2017 Jun 30;1(2):77-87. 9
In immunocompromised hosts, pulmonary TB manifests as
miliary TB, hilar or mediastinal lymphadenopathy, and pleural
effusion on chest radiographs (Fig. 3)
Medicine. 2017 Jun 30;1(2):77-87. 10
Medicine. 2017 Jun 30;1(2):77-87. 11
CT is more sensitive than chest radiography for the detection
and characterization of subtle parenchymal disease and
mediastinal lymphadenopathy. With CT, a diagnosis of
pulmonary TB is correct in 91% of patients and TB is correctly
excluded in 76% of patients
For example, in one study of 41 patients with active TB, CT
whereas chest radiographs
depicted cavities in 58%,
showed cavities in only 22%.
Medicine. 2017 Jun 30;1(2):77-87. 12
Table 1 summarizes the characteristic CT findings of
parenchymal, lymph node, airway, and pleural TB.
Medicine. 2017 Jun 30;1(2):77-87. 13
Medicine. 2017 Jun 30;1(2):77-87. 14
Medicine. 2017 Jun 30;1(2):77-87. 15
TB remains a global health concern. Accurate and rapid diagnosis
of TB and the determination of drug resistance using bacterial,
molecular, and radiographic evaluations are critical for adequate
treatment and for protecting communities.
Medicine. 2017 Jun 30;1(2):77-87. 16
JOURNAL READING
ATELECTASIS

17
2 major causes of an opacified hemithorax:
• Atelectasis of entire lung
• very large pleural effusion
 Atelectasis of an entire lung usually results from complete

obstruction of the right or left main bronchus
 Obstruction cause no air can enter the lung  the remaining air in
the lung is absorbed into the bloodstream through the pulmonary
capillary system  loss of lung volume
18
 In obstruction atelectasis, the visceral and parietal pleura almost
never separate each other  mobile structures in the thorax are
pulled toward the side of the atelectasis  producing a shift
toward the side of opafication
 Atelectasis can be classified either by its pathophysiology or by the
region and extent of lung involved
 These cases include lobar atelectasis and complete lung collapse
19
LOBAR ATELECTASIS
RIGHT UPPER LOBE ATELECTASIS
COMPLETE LUNG ATELECTASIS
COMPLETE LUNG ATELECTASIS
REFERENCES
1. García EB, Sanz CA, Morena AM, Valcarcel PQ, Aldehuela CA,
Sancho CI. Radiological signs of lobar collapse, Chest
radiographic findings and CT imaging correlation. Europian
Society of Radiology. 2011; C-1379
2. Herring W. Learning Radiology Recognizing The Basics. 3rd
Edition: Elsevier, 2015
PNEUMONIA

25
PNEUMONIA
Community Acquired Pneumonia
Hospital Acquired Pneumonia
Nursing Home Acquired Pneumonia

5 KRITERIA
KELUHAN UTAMA MENURUT LABORATORIUM
Heckerling et al
• Demam • Demam > 37,8’ • Leukositosis
• Batuk Berdahak • Takikardia • Kultur Sputum
• Sesak / Nyeri Dada • Rhonki
• Suara Nafas
menurun
• Tidak ada Asma
PEMBAGIAN PNEUMONIA
(BERDASARKAN GAMBARAN RADIOLOGI)
Consolidation (alveolar/lobar pneumonia)
Peribronchial Nodules (bronchopneumonia)
Ground-Glass Opacity (GGO)
Random Nodules Predominant

Consolidation Predominant Pattern
(alveolar/ lobar pneumonia)
• Konsolidasi terbentuk dari proses inflamasi

melalui pores of Kohn / canals of Lambert di
perifer paru
• Etiologi tersering :
-Streptococcus
-Klebsiella
Jenis Foto : Thorax AP
Deskripsi : CTR < 50%
Corakan Bronkovaskular : DBN

Tampak gambaran konsolidasi nonsegmental
pada lobus media paru dextra
Lapisan pleura tidak tampak
Sinus Kostofrenikus lancip
Kesan : Pneumonia Lobaris dextra
Figure 1 Streptococcus pneumoniae pneumonia showing alveolar pneumonia in a man in

his 80s. A: Chest radiograph shows a nonsegmental consolidation in the right middle lung
field, which is demarcated by the minor fissure suggestive of upper lobe pneumonia (arrow);
Jenis Foto : Thorax PA
Corakan Bronkovaskular DBN

Tampak gambaran konsolidasi pada lobus
inferior paru kanan
Kesan : Pneumonia
Figure 2 Mycoplasma pneumoniae pneumonia showing alveolar pneumonia in a woman in

her 30s. A: Chest radiograph demonstrates ill-defined consolidation in the right lower lung field
(arrow);
Jenis Foto : Thorax AP
Corakan Bronkovaskular DBN

Tampak gambaran konsolidasi pada lobus
inferior paru dextra
Kesan : Pneumonia Lobaris inferior

dextra (Pneumonia Alveolar)
Figure 3 Chlamydophila pneumoniae pneumonia showing alveolar pneumonia in a man in his

60s. A: Chest radiograph shows an ill-defined consolidation at the right lower lung field
(arrow);.
Peribronchial Nodules Predominant
(Bronchopneumonia)
• Konsolidasi terbentuk dari pembesaran dari nodule
peribronkial dan terkadang penebalan dinding bronkus
- Hemophilus influenzae,
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Viruses
Corakan bronkovaskular Meningkat

Tampak gambaran retikulonodular dan
konsolidasi pada lobus media sampai lobus
inferior paru sinistra.
Pada Hilus tampak melebar
Kesan : Bronkopneumonia
Figure 5 Mycoplasma pneumoniae pneumonia showing bronchopneumonia in a man in his

10s. A: Chest radiograph shows reticulonodular opacities and focal consolidation in the left
middle to lower lung field (arrow). The left pulmonary hilum appears enlarged;
GROUND-GLASS OPACITY
• Terkadang disebut : pneumonia interstisial
• Berhubungan dengan pengisian alveolar yang tidak
komplit akibat proses inflamasi sel / edema pulmo
sekunder
- Viruses
- Mycoplasma pneumoniae
- Pneumocystis jirovecii
Corakan bronkovaskular DBN

Tampak gambaran nodular pada peribronchial
pada lobus medial paru kanan
Kesan : Pneumonia
Figure 10 Mycoplasma pneumoniae pneumonia showing ground-glass opacity predominant

pneumonia in a woman in her 30s. A: Chest radiograph shows patchy ground-glass opacity
(GGO) with peribronchial nodules in the right middle lung field (arrow);
Figure 14 Pneumocystis jirovecii pneumonia in a man in his 20s. A: Chest radiograph
shows bilateral reticulonodular opacities; B: Chest computed tomography with a 5
mm slice thickness demonstrates bilateral ground-glass opacity with reticulations
RANDOM NODULES PREDOMINANT
• Random nodule diproduksi oleh penyebaran
secara hematogen / infeksi granulomatous
(tuberculosis, nontuberculous mycobacterial
infection or fungal infection)
- Viral
- TB Miliar
Figure 16 : Miliary tuberculosis in a man in his 60s. A: Chest radiograph diffuse
reticulonodular opacities in both lungs.
KESIMPULAN
Imaging findings of CAP are varied and often nonspecific. However, some characteristic findings
are sometimes suggestive of specific pathogens. In addition, imaging examinations, especially
CT, can offer clues to the differentiation between infectious pneumonia and noninfectious
diseases. To accomplish this differentiation, familiarity with imaging characteristics of CAP as
well as those of noninfectious diseases is indispensable.
REFERENSI
Nambu A, Ozawa K, Kobayashi N, Tago M. Imaging of community-acquired pneumonia: Roles of

imaging examinations, imaging diagnosis of specific pathogens and discrimination from
noninfectious diseases. World J Radiol 2014; 6(10): 779-79
TERIMAKASIH
MOHON BIMBINGANNYA


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JOURNAL READING

FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI

World Health Organization. Global tuberculosis report 2016

World Health Organization. Early detection of tuberculosis: an

FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI

 Atelectasis of an entire lung usually results from complete

FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI

Hospital Acquired Pneumonia

Nursing Home Acquired Pneumonia

Consolidation (alveolar/lobar pneumonia)

Peribronchial Nodules (bronchopneumonia)

Ground-Glass Opacity (GGO)

Random Nodules Predominant

• Konsolidasi terbentuk dari proses inflamasi

Corakan Bronkovaskular : DBN

Kesan : Pneumonia Lobaris dextra

Figure 1 Streptococcus pneumoniae pneumonia showing alveolar pneumonia in a man in

Corakan Bronkovaskular DBN

Figure 2 Mycoplasma pneumoniae pneumonia showing alveolar pneumonia in a woman in

Corakan Bronkovaskular DBN

Kesan : Pneumonia Lobaris inferior

Figure 3 Chlamydophila pneumoniae pneumonia showing alveolar pneumonia in a man in his

Corakan bronkovaskular Meningkat

Figure 5 Mycoplasma pneumoniae pneumonia showing bronchopneumonia in a man in his

Corakan bronkovaskular DBN

Figure 10 Mycoplasma pneumoniae pneumonia showing ground-glass opacity predominant

Nambu A, Ozawa K, Kobayashi N, Tago M. Imaging of community-acquired pneumonia: Roles of

FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI

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