Diana Vevy Febrianita

Preseptor :
dr. Dyana, Sp. Rad
Klasifikasi :

1. Soliter
a. Small (d: 0,5-3 cm coin lesion)
Malignancy primer atau sekunder
Adenoma
Hamartoma
Granuloma
Exudat
Arteri-Venous aneurysma

b. Large (d: >3 cm)

Berbatas tegas
Kista dengan cairan penuh
Tumor-tumor dari pleura
Berbatas tidak tegas dan tidak teratur
Abses, granuloma
Infark
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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
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 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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1. Cavitas dengan 1 chamber atau multichamber. Mungkin terisi cairan
, mungkin tidak tampak cairan
2. Dinding jaringan mengalami peradangan
3. Ada fluid level
4. Biasanya lokasinya dipermukaan pleura, sehingga mungkin dapat
rupture kedalam pleura dan membentuk fistula bronchopleural.
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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

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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

A large Aspergillus mycetoma (fungus ball)

within a cavity
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

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b. Pancoasts tumor
Posterior superior pulmonary
sulcus tumor
Posterior costae 1- 3 destruction
with vertebral erosion
Cervicalis symphatis paralysis
Horner syndrome

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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 Metastase intrapulmonal
Chorio Ca
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c. Milliary type
Thyroid Ca
Mammae Ca
Sarcoma
Lung Ca
d. Pleural metastase : Pleura effusion
Mammae Ca
Mesothelioma
Lung Ca
e. Pneumonic type
Oesophagus
Lung
Mammae

f. Lymphatic type
Lung
Gaster
Mammae
Pancreas, etc.

Coarse reticular shadowing 17

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 Silicosis:

Nodules .Bilateral hilar
.lymphadenopathy.
3. Conglomeration & Emphysematous stage .Many of the nodes 18
Nodules conglomerate are calcified.
Asbestosis
Diffuse interstitial fibrosis on both lung field
No nodule
Small bullae or bleb
Pleural fibrosis

Asbestosis
- Shaggy heart
- Linear opacity
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Berylliosis
Factory worker that produce chemical used in petromax
Radiologi :
Like milliary tuberculosis
Increased bronchovascular marking
Confluent lesion, sometimes hazy

- Diffuse reticular shadowing

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 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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 Small nodular, poorly defined, irregular confluent
In middle and basis (ussually)
Pneumatocele

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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

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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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