Presentasi Dr. Tonny

8/12/2019 Presentasi Dr. Tonny

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AIR WAY DISEASEImaging aspect

Tonny K.Sudarmo

Bag.Radiologi FKUI.


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GROUP

1. Air Space Enlargement.

2. Alveolar Filling disorders.


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AIR SPACE ENLARGEMENT

Definition:

An increased in air space size as

compared with airspace of normal

lung.


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AIR SPACE ENLARGEMENT

Simple air space enlargement.Congenital :

Congenital lobar over inflation

Down Syndrome

Acquired:

Secondary to loss of volume

Associated with aging


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Emphysema

Centroacinar

Paraacinar

Distal emphysema

Bullae

Airspace enlargement with fibrosis

Bronchiectasis

Irregular or paracicatrical emphysema

Honey combing ( end-stage) lung


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Air space enlargement

Emphysema

Bronchiectasis

Bullae


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EMPHYSEMA

Characterized by:

Enlarged of the air space distal to the

terminal bronchiole, with destruction of their

wall, and without obvious fibrosis.

Parenchyma distal to the terminal

bronchioleacinus or primary lobe. Large cystic area or bullae develop ( bullous

emphysema)


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TB = Terminal bronchioles

RB = Respiratory bronchiolesA = Alveoli


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A. Acinus

B. Centrilobular

C. Panacinar

D. Paraseptal

E. irregular

AD = Alveolar Duct

AS = Alveolar Sacs


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Type.

a. . Centrilobular

- Destruction is limited to the central part of the

lobule.

- Peripheral alveolar ducts and alveoli may

escape unscathed.- Apex upper lobe, spreads down as the disease

progress.


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Centrilobular

Early

Advance


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Normal acinus Centri acinar


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Type

b. Panlobular.

- Show distention and destruction of the whole

lobule.

- No regional preference, or is more common in

the lower lobes.


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Normal

Panacinar

Panlobular


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Type

c. Distal (paraseptal) emphysema.

- Alveolar duct and sacs are dominantly involved.

- Found deep to pleura and adjacent lobular septa.

- Associated with spontaneous pneumothorax.


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Emphysema

CT observation

- Decreased in lung attenuation.

- Decreased in the diameter and number of

pulmonary vessel


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Emphysema

Technique :

Using High Resolution CT

- Collimation 1 mm.

- High spatial frequency reconstructionalgorithm.

- Scan interval 10 mm.


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Emphysema

The Image

Window level - 600 to - 700 H

Window width 1500 to 1700 H.


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Centriacinar Emphysema

CT Findings :

- Focal area of decreased attenuation without

discernable wall.

- Focal arteriole at or near the center of

emphysema ( interior vessel)


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Centriacinar


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Panacinar Emphysema

CT Findings :

- Large area of decreased attenuation with poorly

defined lateral margin.

- Pulmonary vessel decreased in diameter and

number.


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Panlobular emphysema


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Panlobular emphysema


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Distal Acinar Emphysema

CT Findings :

- Focal area of decreased attenuation in the

sub pleura areas with upper lobe predominance.

- Thin wall and no interior vessel.


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Paraseptal


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Distal


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Paraseptal emphysema


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Paraseptal emphysema


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Bullae

A bulla is an airspace in the lung more

than 1 cm in diameter in the distended

state.

Cl ifi ti


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Classification

Type I :

- Sub pleural and are found in the absence of emphysema.- Multiple and very large.

- Compromise lung function by compression of the

remaining normal lung.

Type II :- Sub pleura but associated with emphysema in the rest of

lung.

Type III :- Located within the lung rather than sub pleural.

- Also associated with emphysema in the rest of the lung.


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Bulla emphysema


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Bulla emphysema


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BRONCHIECTASIS

Defined as permanent abnormal dilatation

of bronchi, but bronchial dilatation also

occur in chronic bronchitis.

Not frequently bronchiectasis and

emphysema occur together

REID CLASSIFICATION


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REID CLASSIFICATION

Group 1: Cylindrical bronchiectasisBronchiole minimally dilated

All bronchi and bronchioles are occluded by purulent material.

Branching bronchial tree is within normal limits.

Group 2: Varicose Bronchiectasis

Characterized by localized bulbous areas of bronchial dilatation.Reduced visible bronchial subdivision from the hilum to periphery.

Group 3: Saccular of cystic bronchiectasis

Grossly distorted bronchi with large saccular terminations filled withpurulent secretion.

Number of bronchial division from hilus to periphery is greatly

reduced.


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CT DIAGNOSIS OF BRONCHIECTASIS

Primary signIdentification of enlarged internal bronchial diameter

Failure if an airway to taper while progressing toward

periphery.Identification of airway in the extreme lung periphery

Indirect sign

Bronchial wall thickening

Mucus impaction

Focal air trapping


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Dilated bronchus run parallelto the plane of

CT Section

Tram track ( Cylindrical Br.)

Beaded appearance ( Varicose Br.)

String of cyst or cluster of cyst ( Cystic Br.)

i i


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Dilated bronchus run perpendicular

to the plane of CT section

Signet ring sign :

Ring structure with internal diameter larger

than that of its accompanying pulmonary arterybranches.


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Mucus impaction seen as:

Nodular density(in cross section)

Tubular or branching structure

- Beaded, glove finger, Y or V shaped

(in the plane of the section)

Air trappingseen as :Mosaic attenuation


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SPECIAL TOPIC

CHRONIC OBSTRUCTIVE LUNG DISEASE.


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Common pathophysiologic abnormality

Persistent increase resistance tobronchial air flow

A. Lumen is partly blocked

B. Wall is thickened

C. Abnormality is outside

I d i


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Increased resistance

Condition:

1. Inside the lumen

occluded by excessive secretion, edema,

aspiration, foreign bodies

2. In the wall of the airway

Loss of elastic recoil, hipertrophic mucous

gland, inflamation/edema.

3. In the peribronchial regionLoss of radial traction, edema, externalcompression.


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Chronic Obstructive Group:

1. Pulmonary Emphysema

2. Chronic Bronchitis

3. Asthma


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Cardinal Symptoms :

1. Cough

2. Dysnea

3. Wheeze

Air flow :

1. Forced expiratory volume in

one second ( FEV1)

2. Forced Vital Capacity (FVC)

Lesion associated with chronic airflow obstruction


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Lesion associated with chronic airflow obstruction

BronchiMucous gland enlargement

Smooth muscle hyperplasiaCartilage atrophy

Inflamation

BronchiolesUsual chronic airflow obstruction

Inflamation

Bronchiolar narrowing

Bronchiolar obliteration

Fibrosis

Muscle increaseGoblet cell metaplasia

Mucus plugging

Bronchiolar totousity

Loss of alveolar attachment

Pigmentation


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Special form of bronchiolitis

-Viral infection, toxic chemical and gasses, rheumatoid arthritis.

- Diffuse pan-bronchiolitis, graft-vs-host disease, heart / lung

- Tranplantation, follicular bronchitis/bronchiolitis, mineral

dust associated bronchiolitis, cryptogenic bronchiolitis

Acinus

- Respiratory bronchiolitis

- Emphysema

- Respiratory airspace enlargement


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A. Interlobular septal

thickening

B. Intralobular interstitialthickening

C. Hineycombing

D. Centrilobular

E. Interstitial nodules

F. Cavitary nodules

G. Airspace nodules

H. Ground glass opacity

I. Lobular emphysema

J. Panlubular

K. Lung cyst

Presentasi Dr. Tonny

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