BAYANGAN RADIO OPAQUE

NODULER
Kelompok 4
Suci Hidha Widiani

Preseptor :
dr. Suherlan, Sp. Rad
dr. Dyana, Sp. Rad

RADIOLOGI
RSUD AL IHSAN

Klasifikasi :
1. Soliter
a. Small (d: 0,5-3 cm coin lesion)
Pulmonary sequestration =

Accessories lobe

b. Large (d: >3 cm)

Lung abscess
Primary lung carcinoma
Pulmonary adenomatosis alveolar

cell ca
Solitary large metastase
Hamartoma
A-V aneurysm
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2.

Multiple

Multiple pulmonary metastasis tumor

Pneumoconiosis
Caplans syndrome (Rheumatoid

pneumoconiosis)
Silo-fillers disease

3. Granular (miliar) d: < 0,5 cm

Miliary TB
Histoplasmosis
Sarcoidosis
Pulmonary Amyloidosis
Alveolar Ca. dari paru
Metastase

Large nodule

Granular nodule

Soliter
A. Large nodular
1.

Lung abscess
Suppurative & necrosis of pulmonary tissue
Etiologi:

- tuberculosis
- Staphylococcal & Klebsiella
pneumonia
- fungal infection
- malignant tumour
- infected cyst
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DD Lung Abscess :
1. Cavernae TBC

Mostly in apex/subapical
Irregular cavity, distinct border with TBC

lesion around them

2. Cavity in malignancy (bronchogenic ca)

Thick wall, irregular/shaggy border
Tumefaction in cavity
Satellite metastatic nodes

3. Pulmonary cyst
- Thin walled
- Solitary/multiple
- Sometimes accompanied by emphysema

4. Mycotic processes cavitation

- Thin walled with fungus ball inside
- Positional change fungus ball changed
- Sometimes with fistula
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A large Aspergillus mycetoma (fungus ball)

2. Pulmonary Carcinoma

a. Bronchogenic Ca
- Often
- Male > Female
- Right > often
- Age : 50 60 y.o.
- Related : Smoking, radioactive/industry material, TBC
- Classified into :
a. Central type
b. Perifer nodular
c. Pneumonic type
d. Miliary type

b. Pancoasts tumor

Posterior superior pulmonary sulcus tumor

Posterior costae 1- 3 destruction with vertebral

erosion

Cervicalis symphatis paralysis Horner syndrome

Pancoasts tumor

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3. Alveolar cell ca (Pulmonary adenomatosis)

Female = Male
40 years
Radiologi:
Small nodules on both lung field with large masses
in right pulmonary base
No visible node enlargement but shows nodal
consolidation in perihiler
Pleura ussualy not affected
Heart normal

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4. Hamartoma
Overgrowth of few tissue such as smooth muscle fibrous cartilage tissue
and vascular

Radiologi :
Round/oval/lobulated shadow with soft tissue density, well-defined
border, diameter 2.5 9 cm.
Calsification inside : pop corn calcification

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5. A-V Aneurysma = Pulmonary Angioma

Dilatation of arterial-vein shunt
Fluoroscopy : Pulsating masses
Ro:
Medial / Inferior lobe
Vascular appearance from hilar turn to mass shadow (nodular)
6. Pulmonary sequestration & Accesorius loben

- Pulmonary sequestration :
Intralobar / extralobar
Segment/lobe
Bronchial branching separated from normal
Vascularised by systemic vascular.
2/3 cases positioned on left postero basal segment
- Accesorius lobe :

One / group lung segment separated from another lung

segment by accesorius fissura.
Ro :
- Solid mass on left / right lung base
- Infected / Connected with bronchus
air fluid level surounded by infected lung tissue

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Large multiple nodular disorder

1. Multiple metastasis tumor
From adjacent organ:
Oesophagus
Thyroid
Mammae
Emboli through pulmonary artery &
bronchial artery
Metastase in lung gave appearance of
a. Golf ball type
Sarcoma
Renal clear cell
Seminoma
b. Coin lesion type
Thyroid
Gaster
Ovarium-uterus
Lymphosarcoma
Chorio Ca
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Metastase intrapulmonal

c. Milliary type

Thyroid Ca
Mammae Ca
Sarcoma
Lung Ca

d. Pleural metastase : Pleura effusion

Mammae Ca
Mesothelioma
Lung Ca
Pneumonic type

Oesophagus
Lung
Mammae

f. Lymphatic type

Lung
Gaster
Mammae
Pancreas, etc.

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Coarse reticular shadowing

2. Pneumoconiosis
Occupational disease
Pulmonary disorder caused inhaled by foreign substance

Lung reaction if invaded by foreign substance

Fibrosis : Silicate
No reaction : Siderosis
Pneumonitis & fibrosis : Beryllium, Mangan, Gas
Fibrosis / allergy : Cotton linen, Bagase, Sugar
Carcinogen : Radioactive, Asbestosis, Arsenic
Silicosis
Symptom appear after 3 years
Radiologi :
1. Lymphatic stage
Vascular + Lymph marking increasing
Homogenous shadows in base

2. Nodule stage
Nodules
3. Conglomeration & Emphysematous stage
16Nodules conglomerate

Asbestosis
Diffuse interstitial fibrosis on both lung field
No nodule
Small bullae or bleb
Pleural fibrosis

Siderosis
Sclerosing only on smaller nodule

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Asbestosis
- Shaggy
heart
- Linear

Berylliosis
Factory worker that produce chemical used in petromax
Radiologi :
Like milliary tuberculosis
Increased bronchovascular marking
Confluent lesion, sometimes hazy

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- Diffuse reticular shadowing

Small nodule

Depending on position:
Apex : Pulmonary TBC
Undefined:
TBC
Mycosis
Bronchopneumonia

Basis
Bronchiectasis + Secondary infection
Hypostatic pneumonia
Aspiration pneumonia

In 2/3 lung medially

Pulmonary oedema & uremic lung

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Bronchopneumonia

Pneumatocele

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Small nodular, poorly defined,

irregular confluent
In middle and basis (ussually)

Pulmonary oedema
Infusion overload
Renal failure oedema
Heart failure oedema
CNS disease : cerebral tumor / post op
Collagen disease
Rheumatoid arthritis
Periarthritis nodosa
Scleroderma
Gas / fluid inhalation
Radiologi :
Smooth / small noduler in medial
Ussualy >> cor

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Small multiple nodule

Milliary TBC
Milliary carcinoma
Pneumoconiosis
Bronchiolitis
Alveolar cell Ca Sarcoidosis
Milliary mycosis
Pulmonary amyloidosis
Bronchiectasy with secondary infection
Interstitial bronchopneumonia
Rheumatic bronchopneumonia
Pulmonary congestion

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Pulmonary cyst
Spherical cavity, thin walled, non-granulomatous, filled with air / fluid.
Klasifikasi :
A. Solitary
Congenital cyst
Infection cyst
Neoplastic cyst
B. Multiple
Apex:
Bleb
Bulla
Basal

Bronchiectasis cyst

Pneumatocele cyst
Undefined

Tuberculosa complication

Complication of other infiltrative processes

Radiologi:

Spherical cavity in all projection except in near diaphragm or chest wall.

If filled full with air radioopaque

If Ruptured to bronchus air fluid level

If infected thick walled, loss of sharp defined

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DD:/ Encapsulated pneumothorax

Congenital cyst
Origin
Embryonal primary lobe
Endoderm disorder mucosa like gaster
Connected / not connected with digestive tract
Solitary thin walled with fluid
Connected with bronchus air fluid level
Hydatid cyst / echinococcus
In the mid & lower zone
Rarely calcification
Size: 1-10 cm
Unruptured cyst:
One/more homogeneous, roughly spherical/oval,
well-demarcated intrapulmonary mass
Ruptured cyst:
A complex ring shadow with two walls

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Bleb & Bulla

Bulla :
Vesicular emphysema area
in lung tissue
> 1 cm
Bleb :
Interstitial emphysema
that located between
visceral pleura and lung
tissue

Bilateral
bullae
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Giant Bulla
Solitary, unilateral asym. lung
Bulla will pushes mediastinum & diaphragma DD:
Pneumothorax
If very large pneumothorax
Pneumatocele
Pure interstitial emphysema
Wall from bronchiali/alveolus
adventitia tunica
In suppurative pneumonia

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THANK YOU

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