LAPORAN PAGI

5 JUNI 2014
RONA KARTIKA
09/KU/13166
 Identitas

 Nama: Tn. N
 Usia: 69 tahun
 No. RM: 01.69.xx.xx
 Alamat: Muntilan, Jawa Tengah
 Klinis: Stroke, CAP
 Foto thorax AP view, posisi supine,
asimetris, inspirasi dan kondisi cukup,
hasil:
 Tampak gambaran opasitas inhomogen
pada pulmo bilateral, dan air
bronchogram (+)
 Kedua diafragma licin
 Cor CTR = 0,53
 Sistema tulang yang tervisualisasi intak
 Kesan

 Bronkopneumonia bilateral
How to read Chest X-ray (PA
view)
 Positioning:
 Patient faces the film chin up.
 The shoulders rotated forward  displace the
scapulae.
 Exposure:
 full inspiration  optimal visualisation of the lung
bases  costa 9-10
 Penetration  centring at T 4-5.
 Prevent obscuring the lung bases:
 the breasts should be compressed against the film.
 Marker R/L
SUGGESTED SCHEME FOR VIEWING THE PA FILM
 Check the costophrenic angles
 Margins should be
sharp
 Check the hilar region
• The hilar – the large
• blood vessels going
• to and from the lung
• at the root of each
• lung where it meets
• the heart.
• • Check for size and
• shape of aorta,
• nodes,enlarged
• vessels
 Finally, Check the Lung
Fields
• Infiltrates
• Increased interstitial
markings
• Masses
• Absence of normal
margins
• Air bronchograms
• Increased vascularity
 HEART
1. R Atrium 2. R Ventricle 3 . Apex of L Ventricle 4. Superior Vena Cava
5. Inferior Vena Cava 6. Tricuspid Valve 7. Pulmonary Valve 8. Pulmonary Trunk 9. R
PA 10. L PA

 Size, Shape,
silhouette-margins
should be sharp
 Diameter (>1/2
thoracic diameter
is enlarged heart)
 AP make heart
appear larger than
it
 actually is.
 Acute Pneumonia
 Bacterial  Non bacterial
Pneumococcus (S.  Mycoplasma
Pneumonia) Pneumonia
Staphylococcus Aureus  Clamidia Psittaci
Haemophylus (psittacosis)
Influenzae  Coxiella Burnetii
Klebsiella Pneumonia  Viral
Legionella  Influenza
Pneumophila  Cold viruses
 Lobar Pneumonia

• Localized infection of terminal air spaces

• Spreads to adjacent lung via the terminal
airways and pores Kohn causes Uniform
consolidation of all or part of lobe
• X ray appearance :
 Homogenous opacification limited by fissures
 Affected lobes retain normal volume
 Often show air bronchogram

• Causes : Streptococcus pneumoniae

Pneumococcal Pneumonia
Lingular and right upper
lobe consolidation with
sparing of the apex
 Bronchopneumonia (Lobular
Pneumonia)
 Multifocal process which commences in
the terminal and respiratory bronchioles
 Spreads segmentally
 Produces patchy consolidation
 Commonly causes:
StapylococcusAureus
Gram negative organism
STAPHYLOCOCCAL BRONCHOPNEUMONIA

The radiograph
eventually return to
normal
 Gram negative pneumonia

. Klebsiella pneumonia. There is consolidation in the right lower lobe

 Clinical practice
 Most useful classification is according to causative
organism
 It is not possible to diagnose the organism from
radiology alone
 Radiology is important to confirming :
 The presence and location of pneumonia
 Following the pneumonia
 Indicate complication :
 Pleural effusion
 Emphyema
 Atelectasis
 Abscess
 Scarring
 Pneumonia: Teori

 Pneumonia is an infection of pulmonary

parenchyma. Pneumonia is not single
disease but a group of spesific infection,
each with different epidemiology,
pathogenesis, clinical presentation and
clinical course
 Etiology of Pneumonia

 Bacterial
 Viral
 Mycosis
 Parasite
 Classification of Pneumonia
 Agent causal Pneumonia :
 Pneumococcal Pneumonia
 Staphylococcal Pneumonia
 Atypical Pneumonia
 Gram negative enteric
Pneumonia
 Anaerobic Pneumonia
 Anatomical :
 Lobar Pneumonia
 Segmental Pneumonia
 Broncho Pneumonia
 Interstitiel Pneumonia
 Clinical:
 Community aquired
Pneumonia
 Hospital aquired Pneumonia
 Aspiration Pneumonia
 Ventilator Associated
Pneumonia
 Pneumonia in
immunocompromised host
 Clinical Presentation

 Typical presentation
 Sudden onset of fever
 Cough productive of purulent sputum
 Some Cases pleuritis chest pain
 Sign of pulmonalry consolidation (dullness, increased fremitus,
bronchial beath sound and rales)
 Leucocytosis

 Atypical presentation
 Gradual onset
 A dry cough
 Extrapulmonary symptom ( haedche, myalgia, fatique, sore throat,
nausea, vomiting, and diarrhea)
 Diagnosis

 Klinis (IDSA 2000) :

 Infiltrat akut pada Rő thorax atau auskultasi menunjukkan
Pneumonia (perubahan bunyi napas/bronkial dan atau ronki
terlokalisasi
 Disertai dua dari gejala infeksi saluran napas bawah
 Demam atau hipotermi, menggigil, banyak berkeringat
 Batuk baru dengan/tanpa sputum atau perubahan sputum
pada batuk kronik
 Chest dyscomfort atau dyspneu
 Diagnosis

 Infiltrat akut pada Rő thorax

 Disertai satu gejala mayor atau 2 gejala minor.
 mayor : - batuk dengan sputum
- temperatur > 37,8 oC
 minor : - pleuritic chest pain

- dyspneu
- perubahan status mental -
konsolidasi paru pada auskultasi
- lekosit > 12.000/mm3
Management