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8/22/2019 13-10 Topic 4. Chest X-Ray anak IDAI
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CHEST X-RAYUKK Pencitraan IDAI
Most frequently performed in pediatric
plain film examination
Assist in establishing preliminary
diagnosis
Monitor the progression of respiratorycondition
Assess the effectiveness of any
implemented treatment
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Plain Film
Standard view AP erect AP supine infants or ill children Lateral localizes an abnormality seen on
AP view
Lateral decubitus (RLD/LLD) small pleural
effusions Oblique pleura, chest wall, ribs
Freddy frog (top lordotic)Upperrespiratory
tract/apical
Standard view AP erect
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AP Supine infants or very sick children
Erect Supine
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Lateral (right lung)
Lateral film localizes an abnormality seen
onAP view
R
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Lateral decubitus (Right-LD/Left-LD)
small pleural effusions
Right-LD
Right-LD
Small pleural effusions
Right-LD
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Right Lateral Decubitus AP Supine
Adequate inspiration
Age of child Optimum inspiration
-3 years 8 posterior ribs
3-7 years 9 posterior ribs
> 8 years 10 posterior ribs
Swischuk:judging the degree of inspiration on a chest filmin an infant/very young child is probably never will be
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Good exposure
Pulmonary vessels
central 2/3 lung fields, no blur
Trachea and major bronchi
be visible
Intervertebrae disc of the lower thoracic
spine
visible through the heart
Good A-P
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Lung A-P
How to examineSystematically described
Mediastinum
Hillar shadows
Cardiac shadow
Great vessels
Lungs
Pleura Diaphragms
Skeletal
Soft tissues
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Lateral The side under investigation
closest to the cassette
Ribs posterior aspect should
be superimposed
The vertebrae should be seen
without rotation
Should include the whole
chest from apices to the
diaphragm
R
Shadow of the chest
A-P Lateral
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Foto Toraks Normal (1)
Mediastinum tidak melebar
Trakea relatif di tengah
Batas jantung jelas
Jantung tidak membesar
Bentuk jantung seperti buah pir
Posisi jantung hemitoraks kiri,
mesokardia
Foto Toraks Normal (2)
Tidak ada kelainan paru
Sudut kosto/kardiofrenikus tajam
Tidak ada kelainan tulang dan
jaringan lunak
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Mediastinum
Tidak melebar
Melebar
Trakea
Tertarik Terdorong
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Batas Jantung
Jelas Tidak jelas
Cardio-Thoracic (CT) Index
b + c
a
~ 0,5 0,6
a
b c
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Ukuran Jantung
Tidak membesar
Membesar
Lokasi Jantung
Mesokardi
Dekstrokardi
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Vaskularisasi normal
Vaskularisasi menurun
Vaskularisasi meningkat
Sinus kostofrenikus
Tajam Tumpul
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Tulang dan Jaringan Lunak
Tulang normal Tulang abnormal
Alveolar process
Consolidation Patchy, fluffy infiltrate
Most commonly result ofbacterial infections
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Consolidation
A
Consolidation
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Patchy infiltrate
Alveolar infiltrate
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Alveolar infiltrate air-bronchogram
Interstitial process
Perihilar/peribronchial infiltrates
thickening of bronchial walls and
peribronchial tissues
perihilar streaky radiations
Most commonly result ofviral infections ormycoplasma
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Perihilar/peribronchial infiltrates
Interstitial process
Pneumonitis Reticulonodularity
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Interstitial process
Diffusely, hazy