hmd radiologi
DESCRIPTION
tugas radiologiTRANSCRIPT
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Hyaline Membrane Hyaline Membrane DiseaseDisease
Department of RadiologyDepartment of Radiology
Kartika 07120080013Kartika 07120080013
Dibimbing oleh : dr. M. Hawari Dibimbing oleh : dr. M. Hawari Abdi, Sp. RadAbdi, Sp. Rad
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ETIOLOGIETIOLOGI
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FAKTOR PREDISPOSISIFAKTOR PREDISPOSISI
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FAKTOR RESIKOFAKTOR RESIKO
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PATOFISIOLOGIPATOFISIOLOGI
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MANIFESTASI KLINISMANIFESTASI KLINIS
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MANIFESTASI KLINISMANIFESTASI KLINIS
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DASAR DIAGNOSISDASAR DIAGNOSIS
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PEMERIKSAAN PEMERIKSAAN PENUNJANGPENUNJANG
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Dalam inspirasi yaitu diafragma setinggi iga belakang 8-10, foto simetris (ujung iga anterior Dalam inspirasi yaitu diafragma setinggi iga belakang 8-10, foto simetris (ujung iga anterior kanan dan kiri terhadap midvertebra berjarak sama, jantung serupa buah pir dan letaknya lebih kanan dan kiri terhadap midvertebra berjarak sama, jantung serupa buah pir dan letaknya lebih
ke kiri dengan apex membulat diatas diafragma, corakan bronkus dan pembuluh darah tidak ke kiri dengan apex membulat diatas diafragma, corakan bronkus dan pembuluh darah tidak melebihi ¼ lapang paru bagian medial, kedua lapangan paru bersih, tulang dan jaringan lunak melebihi ¼ lapang paru bagian medial, kedua lapangan paru bersih, tulang dan jaringan lunak
tidak menunjukkna kelainan.tidak menunjukkna kelainan.
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FOTO THORAX FOTO THORAX
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Kanan (ground glass appearance) kiri (air broncogram)Kanan (ground glass appearance) kiri (air broncogram)
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Grade 1Grade 1
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Grade 2Grade 2
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Grade 3Grade 3
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Grade 4Grade 4
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Air bronchograms (panah hitam). Fisura minor sedikit menebal (panah putih).Air bronchograms (panah hitam). Fisura minor sedikit menebal (panah putih).
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Bell-shaped thorax, volume paru berkurang, Diffused reticulogranular pattern, Air
bronchogram di perifer
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Moderately severe respiratory distress syndrome (RDS). Bintik retikulogranuler Moderately severe respiratory distress syndrome (RDS). Bintik retikulogranuler lebih jelas dan lebih uniform, air bronchogram meningkat.lebih jelas dan lebih uniform, air bronchogram meningkat.
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Buntik retikulogranuler tersebar di kedua lapang paru, , air bronchogram Buntik retikulogranuler tersebar di kedua lapang paru, , air bronchogram prominen, batas jantung hilang. Area kistik pada paru kanan menunjukan prominen, batas jantung hilang. Area kistik pada paru kanan menunjukan
dilatasi alveoli (PIE)dilatasi alveoli (PIE)
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Komplikasi RDS. Setelah terapi ventilasi terjadi pulmonary interstitial Komplikasi RDS. Setelah terapi ventilasi terjadi pulmonary interstitial emphysema (PIE) dengan discrete linear dan cystic radiolucent air emphysema (PIE) dengan discrete linear dan cystic radiolucent air
collection di paru kanancollection di paru kanan..
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Komplikasi RDS. Foto AP menunjukan tension pneumothorax kanan dengan Komplikasi RDS. Foto AP menunjukan tension pneumothorax kanan dengan herniasi paru kanan lobus atas melewati midline. herniasi paru kanan lobus atas melewati midline.
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Transient tachypnea of the newborn (TTN). Hiperaeration ciri khas TTN. Transient tachypnea of the newborn (TTN). Hiperaeration ciri khas TTN. Bilateral reticulogranular densities pada TTN cepat hilang setelah diberikan Bilateral reticulogranular densities pada TTN cepat hilang setelah diberikan
ventilasi, namun pada HMD hilang dalam 3-4 hari. ventilasi, namun pada HMD hilang dalam 3-4 hari.
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Meconium aspiration syndrome. Air trapping; diffuse, opasitas nodular kasar; Meconium aspiration syndrome. Air trapping; diffuse, opasitas nodular kasar; dan area fokal emfisema yang membedakannya dari RDS dimana opasitas nya dan area fokal emfisema yang membedakannya dari RDS dimana opasitas nya
difuse pada RDS. Paru menunjukan gambaran hiperaerated. difuse pada RDS. Paru menunjukan gambaran hiperaerated.
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Airbronchogram (panah)Airbronchogram (panah)
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HMD DAY 1HMD DAY 1
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HMD (KANAN) NORMAL CXR (KIRI)HMD (KANAN) NORMAL CXR (KIRI)
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HMD GRADE 4HMD GRADE 4
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HMD DENGAN PULMONARY INTERSTITIAL EMPHYSEMAHMD DENGAN PULMONARY INTERSTITIAL EMPHYSEMA
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Silverman-Anderson Silverman-Anderson ScoreScore
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TERAPI SUPORTIF TERAPI SUPORTIF
• Memberikan lingkungan Memberikan lingkungan yang optimalyang optimal
• Oksigen intranasal 1-2 Oksigen intranasal 1-2 liter/menit atau liter/menit atau headbox dengan headbox dengan konsentrasi oksigen 30-konsentrasi oksigen 30-60%60%
• IVFD Dekstrose 7.5% IVFD Dekstrose 7.5% atau 10% + NaCl 15% atau 10% + NaCl 15% 6cc6cc
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TERAPI SUPORTIFTERAPI SUPORTIF
• Antibiotika polifragmasiAntibiotika polifragmasi• Ampisilin 100 mg/kgBB/hari dalam Ampisilin 100 mg/kgBB/hari dalam
3-4 dosis3-4 dosis• Gentamisin 2 ½ mg/kgBB/18 jam Gentamisin 2 ½ mg/kgBB/18 jam
bila BB > 2000 grbila BB > 2000 gr• Gentamisin 2 ½ mg/kgBB/24 jam Gentamisin 2 ½ mg/kgBB/24 jam
bila BB < 2000 grbila BB < 2000 gr
• Ventilasi mekanikVentilasi mekanik
• Pemberian peroral ditunda hingga Pemberian peroral ditunda hingga frekuensi nafas < 60 kali/menitfrekuensi nafas < 60 kali/menit
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TINDAK LANJUTTINDAK LANJUT
• PENGAMATAN RUTIN :PENGAMATAN RUTIN :• Tanda-tanda vital dan bentuk pernapasanTanda-tanda vital dan bentuk pernapasan• Awasi tanda-tanda kegagalan pernapasan, infeksi, Awasi tanda-tanda kegagalan pernapasan, infeksi,
asidosis, dan gagal ginjal akutasidosis, dan gagal ginjal akut• Pemeriksaan laboratorium rutin : Pemeriksaan laboratorium rutin :
Hemoglobin Hemoglobin LeukositLeukositDifferential countDifferential countAnalisa gas darah, pada tahap awal tiap 2 Analisa gas darah, pada tahap awal tiap 2
jam (jika jam (jika keadaan membaik dijarangkan)keadaan membaik dijarangkan)Urin diukurUrin diukurElektrolit diperiksa sekali sehariElektrolit diperiksa sekali sehari
Diamati kemampuan minum dan pertumbuhan berat Diamati kemampuan minum dan pertumbuhan berat badanbadan
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KOMPLIKASIKOMPLIKASI
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PROGNOSISPROGNOSIS
•80 – 90 % meninggal80 – 90 % meninggal
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