CASE CLINICAL SESSION ATELECTASIS

Oleh : Yaniar Susin Kelompok 2 Angk. 5

SMF RADIOLOGI PROGRAM PENDIDIKAN PROFESI DOKTER (P3D) FAKULTAS KEDOKTERAN UNISBA RSUD AL IHSAN BANDUNG 2012

DEFINISI
Suatu keadaan paru atau sebagian paru yang mengalami hambatan berkembang secara sempurna sehingga aerasi paru berkurang atau sama sekali tidak berisi udara

Normal lung volumes and fissures.

Frontal (A) and lateral (B) views of the chest show normal positions of the minor (horizontal, right-sided) and major (oblique, bilateral) fissures. The major fissures are often superimposed on the lateral chest radiograph and are usually not seen on the frontal view.

Relaksasi / Kompresif/ Pasif

Sikatrik / Kontraksi

BERDASARKAN MEKANISME :

Absorbsi/ Obstruktif/ Resorbsi

Adesif

Relaksasi / Kompresi / Pasif

- Adanya akumulsi udara / cairan di rongga pleura - Karena pneumothorax; efusi pleura; hernia difragmatika

Absorbsi / Obstruktif / Resorpsi

- Ada obstruksi atau oklusi lumen bronkus disertai absorbsi udara di jaringan paru bag. Distal - Sumber obstruksi : a. Dalam bronkus : tumor bronkus, benda asing, bronkial stricture, cairan sekresi yg masif b. Luar bronkus : tumor sekitar bronkus, kelenjar membesar(KGB)

Adesif
- Akibat gangguan pada surfaktan - Pada ADRS, HMD, emboli paru

Sikatrik / Kontraksi
- Akibat proses fibrosis pada paru atau pleura --- membuat paru menjadi kaku --compliance paru --- expansi paru terhambat - Pada Tb, histoplasmosis

GAMBARAN RADIOLOGIS
Primary Sign
Perubahan letak fisura interlobaris Hipoaerasi --- densitas --- radiopaque Corakan bronkovaskular

Secondary sign

Elevasi diafragma Pergeseran mediastinum Pergeseran trakea Pergeseran letak hilus Hiperaerasi kompensasi paru yang N Penyempitan sel iga

KLASIFIKASI
1) ATELEKTASIS LOBAR
a. Atelektasis lobaris bawah b. Atelektasis lobaris tengah c. Atelektasis lobaris atas

2) ATELEKTASIS SEGMENTAL 3) ATELEKTASIS LOBULARIS

Atelektasis lobaris bawah

Left lower lobe atelectasis. A: Frontal view of the chest shows loss of the medial
left hemidiaphragm border, elevation of the left hemidiaphragm, and increased opacification of the left medial lower lung (stippled area). B: Lateral view shows increased opacification of the posterior inferior lung (stippled area).

Jika terjadi di kiri : diafragma akan terlihat lebih tinggi Traksi fisura mayor

Left lower lobe Collapse

PA chest radiograph of a 65-year-old woman shows inferior displacement of the left major fissure (arrows) and a triangular area of abnormal opacity projected over the left heart.

Lateral view shows :

abnormal opacity overlying the lower spine (circle), the so-called spine sign.

Atelektasis lobaris tengah

Right middle lobe atelectasis. A: Frontal view of the chest shows loss of the right heart border and an ill-defined area of increased opacification in the right medial lung (stippled area). B: Lateral view shows triangular area of opacification (black area) overlying the heart, with approximation of the minor and major fissures.

Disebabkan peradangan atau penekanan bronkus oleh KGB besar

Bayangan berbentuk triangular sebelah jantung

Silhoutte sign (+)

Right middle lobe segmental collapse

PA chest radiograph of a 52-yearold woman with shortness of breath and cough shows : hazy opacity in the right medial lung and loss of the right heart border.

Lateral view shows :

linear opacity overlying the heart (arrows), representing the collapsed right middle lobe.

Atelektasis lobaris atas

Right upper lobe atelectasis. A: Frontal view of the chest shows elevation of the minor fissure and increased opacification of the right upper medial lung (black area). B: Lateral view shows elevation of the minor fissure and superior portion of the right major fissure, as well as opacification of the upper lung.

Bayangan densitas tinggi

Penarikan fissura interlobaris ke atas (fisur minor terangkat) Trakea tertarik ke lesi

Hillus tertarik ke atas

Right upper lobe segmental atelectasis

Posteroanterior (PA) chest radiograph of a 35-year-old man with lithoptysis (literally coughing up stones, but representing calcified lymph nodes that have eroded into the airway, usually secondary to tuberculosis or histoplasmosis) shows : partial collapse of the right upper lobe. The minor fissure is elevated (arrows), outlining the inferior margin of the opacified, atelectatic lung. Note calcified densities (arrowheads) overlying the opacified lung centrally and peripherally.

Lateral view shows :

elevation of the minor fissure (arrows) outlining the inferior margin of the opacified, atelectatic right upper lobe

ATELEKTASIS SEGMENTALIS
Sulit dikenali dg foto PA

Terdapat pereselubungan

Penarikan fisura interlobaris

Triangular (segmental)
Anteroposterior opacity in the lower field. This sits directly on the diaphragm

Triangular (segmental)
Lateral opacity in the lower field. This sits directly on the diaphragm.

ATELEKTASIS LOBULARIS
Penyumbatan di bronkus kecil

Bayangan horizontal tipis, biasanya di base penurunan volume paru yg cukup besar pergeseran struktur rongga dada Fleischners line

Pneumoni

Efusi Pleura

Atelektasis

ada penarikan mediastinum

Ada penarikan Ada penarikan mediastinum ke arah mediastinum ke arah N lesi Air bronchogram (-)
Interkostal space lebih lebar di bag. Lesi Iga melebar dan lebih datar Meniskus sign (+) Meniskus sign (-)

Air bronchogram (+)

Interkostal space masih N

Air bronchogram (-)

Interkostal space masih lebih sempit di bag lesi Iga menyempit dan lebih miring

Iga normal

Meniskus sign (-)

TERIMAKASIH