4. HamartomaOvergrowth of few tissue such as smooth muscle fibrous cartilage tissue and vascularRo :Round shadow, distinct border diameter 2,5 9 cmSoft tissue densityCalsification inside : pop corn calcification

5. A-V Aneurysma = Pulmonary AngiomaDilatation of arterial-vein shuntFluoroscopy : Pulsating massesRo: Medial lobe, Inferior lobeVascular appearance from hilar turn to mass shadow (noduler)

6. Pulmonary sequestration / Accesorius lobeIntralobar / extralobarOne lung segment / Group lung segment Bronchial branching separated from normal2/3 cases positioned on left postero basal segment

6. Pulmonary sequestration / Accesorius lobeRo :Solid mass on left / right lung baseInfected / Connected with bronchus air fluid level surounded by infected lung tissue

Large multiple noduler disorder1. Multiple metastasis tumorFrom adjacent organ:OesophagusThyroidMammaeEmboli throughPulmonary arteryBronchial artery

Metastase in lung gave appearance ofa. Golf ball typeSarcomaRenal clear cellSeminoma

b. Coin lesion typeThyroidGasterOvarium uterusLymphosarcomaChorio Ca

c. Milliary typeThyroid CaMammae CaSarcomad. Pleural metastase : Pleura effusion

e. Pneumonic typeOesophagusLungMammaef. Lymphatic typeLungGasterMammaePancreas

2. PneumoconiosisOccupational diseasePulmonary disorder caused inhaled by foreign substanceLung reaction if invaded by foreign substanceFibrosis : SilicateNo reaction : SiderosisPneumonitis & fibrosis : Beryllium, Mangan, GasFibrosis / allergy : Cotton linen, Bagase, SugarCarcinogen : Radioactive, Asbestosis, Arsenic

SilicosisSymptom appear after 3 yearsR :1. Lymphatic stageVascular + Lymph marking increasingHomogenous shadows in base

2. Nodule stageNodules3. Conglomeration & Emphysematous stageNodules conglomerate

AsbestosisDiffuse interstitial fibrosis on both lung fieldNo noduleSmall bullae or blebPleural fibrosisSiderosisSclerosing only on smaller nodule

BerrylosisFactory worker that produce chemical used in petromax R :Like milliary tuberculosisIncreased bronchovascular markingConfluent lesion, sometimes hazy

Small multiple nodule disorderMany, most important disorder areMilliary TBCMilliary carcinomaPneumocoliosisBronchiolitisAlveolar cell CaMilliary mycosisCont..

SarcoidosisPulmonary amyloidosisBronchiectasy with secondary infectionInterstitial bronchopneumoniaRheumatic bronchopneumoniaPulmonary congestion

PatchydisorderDepending on position1.Apex : Pulmonary TBC Mycosis Bronchopneumonia Loefler sindrome

Patchy disorder 2.Medial:Oedem pulmonalBronchopneumoni 3.Basis:BronchopneumoniBronchiectasiAspirasi pneumoni

Adult TBC1. Minimal lesionNo cavitationUnilateralAffecting apex to thoracal 4-52. Moderate lesionUnilateral / bilateralLesion rarely more than one lungLesion is solid in more than 1/3 of lungCavitation is less than 4 cm

3. Far advance : > moderate lesion4. Chronic fibroidConstriction because of fibrosisShrinking of hemithoraxTracheal deviation / pulledHili tracted upwardShrinking of intercostal spaceTraction diaphragm / heart

BronchopneumoniaSmall noduler, poorly defined, irregular confluentIn middle and basis (ussually)

Pulmonary oedemaInfusion overloadRenal failure oedemaHeart failure oedemaCNS disease : cerebral tumor / post opCollagen diseaseRheumatoid arthritisPeriarthritis nodosaSclerodermaGas / fluid inhalation

Pulmonary oedemaRoSmooth / small noduler in medialUssualy >> cor

BronchiectasisPatophysiology a. Bronchial wall inflamation Peribronchial scarring bronchi became unelastic intraluminal pressure increase dilatation of bronchusb. Secondary inflamation on bronchus scar tissue bronchial dilatation

Type : Cylindrical Sacculer VaricoseRo:In latter stage shows reticular shadowing/ honeycombingBronchial wall thickening

Radioopaque disorder with increased linesLines shadow is caused by :ArteriesVeinLymphatic Bronchus

ArteryActive hyperemi

RoStraight line shadowsDistinct borderDiameter < veinHili not enlarge

VeinPasive hyperemi On Pulmonary congestion Decomp. CordisRoSnaking linesPoorly definedDiameter > arteryHili enlarged

BronchusChronic infection on bronchus expand to peribronchial connective tissue fibrosis Chronic Bronchitis, PneumoconiosisPulmonary oedema, EmphysemaRoHoneycombReticular in lung base

Lymph. vesselMediastinal node enlargementLymphoma and lymphogen metastase of malignant tumorRoStelate line shadow expanding from hilus periferEnlarged hili, kerley lines

Cor pulmonale chronicum Lung chronic disorder that cause heart disorderEmphysema pulmonumVascular sclerosisPulmonal stenosisCongestive heart disease with left to the right shuntPulmonal fibrosis

RoRight ventricle >Apex is upward and roundedBulging of pulmonal segment (enlargement of Pulmonary artery)Pulmonary emphysemaIncreased bronchial lines

Pulmonary congestion on heart failure Passive hyperemiaRo:Vein dilatation Dilatation of Pulmonary artery SecondaryHili EnlargedShadowing in 2/3 medialCor >>, left > rightSometimes accomp. by pleural effusionDiaphragma elevation if accomp, by ascites / hepatomegali

Pulmonary fibrosisFibrosis from interstitial tissue, perivascular and peribronchialOnSclerodermaLipoid storage diseaseInhalation agentRadiationDrugs : Bleomycin

Ro:Diffuse Reticular shadows & Emphysema in base / middle fieldFlatening of costaeDiffuse radiolucencyLow position diaphragmSmall heart (tear drops)

Pulmonary disorder with increasing radiolucencyExtrapulmonarya. Air trapped in normal space : Pneumothoraxb. Air trapped in abnormal space :Hernia diaphragmaticaSubphrenic colon interpositionDiaphramatic eventration

Intrapulmonarya. Circumscript cavityCystAbscess

b. Generalized1. Over distentionBall valve type obstructionEmphysema2. VascularCongestive pulmonary stenosisPulmonary emboli ( without infarction)Pulmonary arterial displasia

Pulmonary cystSpherical cavity, thin walled, non granulomatous, filled with air / fluid

ClassificationA. SolitaryCongenital cystInfection cystNeoplastic cyst

B. MultipleApexBlebBlulla

BasalBronchiectasis cystPneumatocele cystUndefinedTuberculosa complicationComplication of other infiltrative processes

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

DD:/ Encapsulated pneumothorax

If filled full with air radioopaqueIf Ruptured to bronchus air fluid levelIf infected thick walled, loss of sharp defined

Congenital cystOriginEmbryonal primary lobeEndoderm disorder mucosa like gasterConnected / not connected with digestive tractSolitary thin walled with fluidConnected with bronchus air fluid level

Hydatid cyst / echinococcusCyst s Outer wall fibrous tissueWall that border daughter & granddaughter cyst hyalin tissue Filled with fluid

RoIf ruptured ordinary cystIf ruptured separated ectocyst from adventitia tunica cyst showed with double walledRarely calcifiedCyst > 10 cm

Bleb & BullaBulla : Vesicular emphysema area in lung tissueBleb : Interstitial emphysema that located between visceral pleura and lung tissue

Giant Bulla Soliter, unilateral asym, lungBulla will pushes mediastinum & diaphragma DD: PneumothoraxIf very large DD: pneumothorax

PneumatocelePure interstitial emphysemaWall from bronchial alveolus adventitia tunicaIn suppurative pneumonia

Pulmonary emphysemaDilatation of part / whole lung that filled with excessive airClassificationa. General / Localb. Acute / Chronicc. Static / Progresive

Acute emphysema1. Acute obstructive emphysemaObstruction : Airways ball valve obstruction2. Acute vesicular emphysemaObstruction on bronchioles because of inflamation processes in bronchioli / lungIn staphylococ pneumonia

3. Acute interstitial emphysemaAir is forced into pulmonary interstitialIn: PertussisPenetration wound in thorax

4. Mediastinal EmphysemaAir is entering mediastinum On Trauma : Tracheal perforation / oesophagus mediastinumIn PertussisRo : Luscent lines in mediastinum

Chronic emphysemaEtiologi : UnknownIn : Chronic cough / people that work with wind producing instrument

RoWidening of thorax transversal and AP diameterFlatening of costaeLung hyperlucencyInterstitial fibrotic app. Small and narrow heartEnlargement and wide vascularLateral photo shows enlargement of anterior mediastinum

Senile emphysemaAtrophy of alveoly wall that caused chronic pulmonary emphysema because of interstitial fibrosis

Compensatory bullous emphsemaCause : vanishing diseaseIf the process is progresive in one periode serial photoPresenting with cor pulmonalePulmonary segmen bulging, vascular, bulging and widening of hili