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Selasa, 16 April 2013

Melihat Jantung Pada Proyeksi Rontgen (Bagian I)

Bermain-main dengan program “Virtual Heart
Untuk menilai dengan cepat keadaan jantung dalam foto X-Ray idealnya kita harus mengetahui foto tersebut dibuat dalam keadaan inspirasi penuh atau ekspirasi. Dalam keadaan menilai dengan ringkas hal-hal tersebut terkadang terlewatkan, terutama bagi tenaga medis yang bekerja di ruang emergency. Namun apa salahnya kita dengan cepat menilai posisi jantung selagi menunggu koreksi foto thorax selanjutnya.

Sebaiknya foto dibuat dua yakni Thorax PA dan Proyeksi Lateral untuk lebih memudahkan penilaian kita. Penyakit jantung kongestif, cardiomegali, penyakit jantung rematik, VSD, dan sebagainya tentunya merupakan hal yang menakutkan jika terlihat dengan kasat mata. Untuk itu kecermatan dalam berlatih sangat dibutuhkan. Baiklah langsung saja kita lihat bersama-sama di bawah ini. Untuk lebih jelasnya saya gunakan program 3D “The Virtual Heart versi 1.1” yang dibuat oleh ahli kardiovaskular ternama Spanyol yaitu dr. Jose Luis Zamorano yang berkolaborasi bersama dr. Pedro Marcos Alberca. Program ini bagus sekali karena kita seperti menyelam ke dalam fisiologis jantung yang sesungguhnya lengkap dengan audio visual dan echocardiografi yang sama persis dengan aslinya.

Kita mulai dengan posisi jantung dan organ-organ lain yang mengapitnya

Jantung kita ditempatkan oleh "Sang Pencipta" persis di tengah dada kita, diapit oleh dua paru kanan dan kiri, terletak diatas diaghfragma dan dilindungi oleh sternum beserta tulang rusuknya. 

Jantung memiliki selaput yang sangat kuat yang disebut perikardium yang berfungsi membungkusnya dan melindunginya layaknya sebuah pakaian. 

Jantung berdenyut (pada dewasa) sekitar 60-100 kali permenit dalam keadaan istirahat. Setiap detakan memompa sekitar 70 ml darah. Angka ini dapat ditingkatkan dengan olahraga sehingga pada atlit detakan jantung cenderung lambat (bradikardia) namun efektif.

Baiklah kita mulai satu persatu

1. Ini adalah Aorta

Tampak foto dari proyeksi PA ini adalah proyeksi aorta. Bagaimana ?, Jelas bukan ?
Untuk menilai ada tidaknya penebalan katub aorta seperti penyakit mitral stenosis dapat dinilai dari pemeriksaan echocardiografi. Paling tidak dengan melakukan pengamatan dengan cepat melalui rontgen awal dapat memperkirakan arah menuju diagnosis selanjutnya.





1B. Aorta tampak proyeksi lateral


















2. Arteri Pulmonary Dextra
3. Artery Pulmonary Sinistra

4. Atrium Dextra
















5. Atrium Sinistra


6. Diaphragma
















7. Trachea
















8. Pulmonary Trunk
















9. Vena Cava Superior
















10. Right Ventricle
















11. Left Ventricle
















Bagaimana ? Asyik bukan ?

Kunsantri Nurrobbi, MD
Dapat direvisi kemudian

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