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 27
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 29
Interstitial Opacity: Lines
Image credit: Curry International Tuberculosis Center, University of California, San Francisco 29
Interstitial Opacity: Lines & Reticulation
Image credit: Curry International Tuberculosis Center, University of California, San Francisco 30
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 32
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 36
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
45 year old man
from China with
cough, weight loss
C
D
B
Image credit: Curry International Tuberculosis Center, University of California, San Francisco 42
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
46
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
TB Pattern
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
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CXR Pattern: Early vs. Advanced HIV
Early HIV
(CD4>200)
Advanced HIV
(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