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DISKUSI TOPIK

TUBERCULOSIS PARU

WENDY WONGSO

I111 11 025

KEPANITERAAN KLINIK RADIOLOGI RS UNTAN

PERIODE 29 FEBRUARI 2016 – 26 MARET 2016


2/20

TUBERCULOSIS

• Tuberculosis is a chronic infection causeMycobacterium tuberculosis , aectin maires!iratory tract, thouh it can in"ol"e any sythe body# The immirant !o!ulation, debilitimmunosu!!ressed !atients are all !rone

infection#

• The e"aluation of a !atient $ith sus!ected TBbein $ith a Mantou% s&in test '!uri(ed deri"ati"e )**+- and a chest %.ray# *ulmonary!rimary or secondary forms $ith a "ar


3/20

*emeri&saan Radioloi

•*ada tuberculosis !aru, !emeri&saan foto tora&men0adi !emeri&saan usulan namun bu&an dianosa utama#

• *emeri&saan foto thora& da!at menyi&emun&inan TB !aru !ada oran.oran den

tuberculin '1- dan tan!a e0ala#

• *embuatan foto thora&s denan !roye&si *2 '2nterior-, bila !erlu disertai denan !roye&si.

lain se!erti foto lateral dan foto &husus !un


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•

Bila !ada &linis dida!at&an e0ala tuberculosis, ham!ir selalu &elainan !ada foto ronten

• Bila &linis ada duaan terhada! !enya&it tuberculosis !aru, teta!ronten tida& ada &elainan, ma&a hal ini belum berarti tida& ada tsebab &elainan !ertama !ada foto tora&s baru terlihat se&uran.&uminu setelah infe&si oleh basil tuberculosis#

• Sesudah s!utum !ositif !ada !emeri&saan ba&terioloi, tanda tuberc

ter!entin adalah &elainan foto tora&s• +itemu&annya &elainan !ada foto tora&s belum berarti bah$a !enya

a&tif

• *emeri&saan roenten !entin untu& do&umentasi, menentu&an!roses dan tanda !erbai&an atau !erburu&an denan mela&u&an !edenan foto.foto sebelumnya#


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•

2da bebera!a cara !embaian &elainan yan da!at difoto ronten# Salah satu !embaian adalah menuru&elainan, yaitu5• Saran e&sudatif, berbentu& a$an.a$an atau berca&, yan

tida& teas denan densitas rendah#

• Saran !rodu&tif, berbentu& butir.butir bulat &ecil yan bata

dan densitasnya sedan#• Saran induratif atau (brotic, yaitu yan berbentu& aris.ari

tebal, berbatas teas denan densitas tini

• 6a"itas

• Saran se!erti aris.aris '(brotic- atau bitni&.bitni& &a!ur yan biasanya menun0u&&an !roses telah tenan#


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•

+i Indonesia, cara !embaian temuan yan seridiuna&an, yaitu5

• Saran.saran berbentu& a$an atau berca&.berca& ddensitas rendah atau sedan denan batas tida& teSaran.saran se!erti ini biasanya menun0u&&an bah!roses a&tif#

• Luban 'ca"itas-, ini selalu berarti !roses a&tif &ecualuban sudah sanat &ecil, yan dinama&an luban s'residual ca"ity-#

• Saran se!erti aris.aris '(brotic- atau binti&.binti& '&alsi(&asi- yan biasanya menun0u&&an bah$a !rose

tenan#


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6emun&inan.6emun&inan6elan0utan Suatu Saran

Tuber&ulosis•

*enyembuhan• *enyembuhan Tan!a Be&as

• *enyembuhan denan meninal&an cacat

• *erburu&an• *leuritis

• *enyebaran miliar

• Stenosis bron&us

• Timbulnya luban 'ca"itas-


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*rimary Tuberculosis

• *rimary TB beins as initial inoculation in the luns#

• Most healthy !atients $ill contain the infection $ith no radiora!hic abnormalmost **+.!ositi"e !atients $ill ha"e a normal chest radiora!h#

• Some !rimary infections $ill create enouh of an in7ammatory res!onse to !ronodule's- and thoracic lym!h node's-#

• 8hen this occurs, it lea"es a characteristic radiora!hic !attern &no$n as in7ammatory com!le%: or Ran&e com!le%# ;o$e"er, this com!le% is not s!eci(c fo

• It is also commonly seen $ith funal or histo!lasmosis infection, !articularly in th

eastern reions of the United States#•


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Secondary Tuberculosis

•

The secondary form of TB in"ol"es reacti"ation of dormant foci of in• The infection thri"es in areas of hih o%yen concentration, !artupper lobes#

• Fibronodular consolidation may occur with or without caviadenopathy.

• In end stae of reacti"ation TB, there is fbrosis and scarring wloss, shit o fssures and/or vessels, and calcifcation.

• Once aain, old chest radiora!hs are crucial in these cases tointer"al chane#

• 2ny !atient $ith a radiora!h suesti"e of TB should ha"e a studmonths !rior made a"ailable for re"ie$#

• 2ny ne$ chanes may indicate reacti"ation disease#


10/20


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12/20

*rimary Tuberculosis# 2!osteroanterior chest radiora!h ina [email protected] old homeless man sho$sairs!ace disease $ithin the anteriorsement of the riht u!!er lobe ,

$ith riht hilar 's&inny arro$- and!aratracheal 'fat arro$- nodeenlarement#


13/20

Tuberculosis left u!!er lobe#

2# Arontal radiora!h sho$sconsolidation and ca"itary disease

'blac& arro$-#


14/20

Tuberculosis# The classic a!!earanceof reacti"ation tuberculosis is that ofan u!!er lobe in(ltrate


15/20

*ost !rimary 'reacti"ation- Tuberculosis# Bilateral u!!er lobereticulonodular o!acities $ith a riht

u!!er lobe ca"ity#


16/20

Old healed calci(ed tuberculous foci'arro$s-#


17/20

*ost *rimary Tuberculosis# The chestradiora!h demonstrates rihtu!!er lobe $ell marinated and!erha!s calci(ed nodular o!acities,as $ell as sini(cant loss in the left

u!!er lobe $ith u!$ard retraction ofthe left hilum and a!ical !leuralthic&enin#


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19/20

Miliary tuberculosis in a !atient $ithacuired immunode(ciencysyndrome#


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TERIM2 62SI;

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