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The role of Chest HRCT in diagnosis active tuberculosis & lung destruction Soekardi, Adi; Icksan, Aziza Ghanie; Ernes, Audrina
Jurnal Prima Medika Sains Vol. 5 No. 2 (2023): December
Publisher : Program Studi Magister Kesehatan Masyarakat Universitas Prima Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34012/jpms.v5i2.4466

Tuberculosis is a public health problem caused by Mycobacterium tuberculosis. In 2021 there will be 10.6 million cases in the world, and Indonesia ranks 2nd with 700,000 cases. In 2022, there will be 17,303 cases in North Sumatra Province and 2,430 cases in Medan City. In current practice, evaluation and diagnosis of active tuberculosis relies on bacteriological examination and Chest Radiographs. However, Chest Radiographs have limited specificity and high intraobserver and interobserver variability. HRCT is also not widely used as a routine option for patients suspected of suffering from tuberculosis, even though HRCT has high accuracy in detecting tuberculosis. We present a case of a patient with active pulmonary tuberculosis and lung destruction e.c. advanced pulmonary tuberculosis (MDR-Tuberculosis) (declared cured in 2018 after 2 years of treatment). This patient was evaluated with chest radiograph and chest HRCT. In this case, the initial findings on the Chest Radiograph, showed the impression of inactive tuberculosis but on further examination with chest HRCT, there was a tree in bud image which indicated active tuberculosis. This shows that there are limitations in diagnosing tuberculosis activity using Chest Radiographs. Due to the significant role of HRCT in the diagnosis of tuberculosis activity, it is necessary to consider the use of HRCT in the evaluation of patients with tuberculosis.

Chest CT as a Complement to RT-PCR to Confirm and Follow-up COVID-19 Patients Icksan, Aziza Ghanie; Hafiz, Muhammad; Harlivasari, Annisa Dian
Medicinus Vol 9, No 3 (2020): June 2020
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v8i1.3122

Background : The first case of COVID-19 in Indonesia was recorded in March 2020. Limitation of reverse-transcription polymerase chain reaction (RT-PCR) has put chest CT as an essential complementary tool in the diagnosis and follow up treatment for COVID-19. Literatures strongly suggested that High-Resolution Computed Tomography (HRCT) is essential in diagnosing typical symptoms of COVID-19 at the early phase of disease due to its superior sensitivity (97%) compared to chest x-ray (CXR).The two cases presented in this case study showed the crucial role of chest CT with HRCT to establish the working diagnosis and follow up COVID-19 patients as a complement to RT-PCR, currently deemed a gold standard.

CT evaluation of pediatric airway foreign bodies: Emphasis on the role of CT scanning in foreign body removal with bronchoscopy Siregar, Indra Riris Delima; Soekardi, Adi; Icksan, Aziza Ghanie
Jurnal Prima Medika Sains Vol. 6 No. 2 (2024): December
Publisher : Program Studi Magister Kesehatan Masyarakat Universitas Prima Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34012/jpms.v6i2.6257

A foreign body that enters the airway through aspiration may become lodged in the trachea, bronchi, or larynx. The size, shape, and type of the foreign body determine where it should be lodged. Children are more frequently impacted. Unexpected inspiration during play or fighting while holding something in their mouths can result in accidents. The first study of choice for any child being evaluated for foreign body aspiration is still a plain film chest X-ray. Computerized tomographic examinations have a slightly higher sensitivity. We report a case of aspiration foreign body in a 12-year-old boy with the main complaint of choking. On physical examination, there were decreased breath sounds and wheezing in the upper left lung area. Chest x-ray revealed a radioopaque needle pin-like foreign body and no abnormalities in both lung. The results of a chest computed tomography (CT) scan showed a needle was abaout 4cm long and located in left bronchus. Once the diagnosis is made, removal of the foreign body with bronchoscopy is performed in these cases. Chest CT scans may need less time for evaluation and provide finer image resolution, making it easier to identify the position, size, and form of AFBs. As a result, chest CT scans offer great potential usefulness in the investigation of suspected AFBs.

Association between cardiothoracic ratio and aortic arch calcification with estimated glomerular filtration rate in hypertensive patients Pratomo, Fransiskus Aryo; Icksan, Aziza Ghanie; Nasution, Ikhwanul Hakim
Jurnal Prima Medika Sains Vol. 7 No. 1 (2025): June
Publisher : Program Studi Magister Kesehatan Masyarakat Universitas Prima Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34012/jpms.v7i1.6677

Hypertension remains a leading cause of global cardiovascular mortality, including in Indonesia. Target organ damage, particularly renal impairment, underscores the need for easily obtainable biomarkers for early detection. Although not explicitly recommended in current guidelines, the cardiothoracic ratio (CTR) and aortic arch calcification (AAC), both assessable via chest radiography, represent readily available and cost-effective screening tools. This study aimed to evaluate the association between these radiographic markers and decreased estimated glomerular filtration rate (eGFR) in hypertensive patients at Royal Prima Hospital, thereby addressing a crucial knowledge gap in resource-limited settings with restricted access to advanced imaging modalities. A cross-sectional analysis was conducted involving 175 hypertensive participants, stratified according to their chronic kidney disease (CKD) stage. Baseline demographics, hypertension status, CTR, AAC, and eGFR were assessed. Bivariate correlation and multivariate regression analyses were performed to determine the relationships between CTR, AAC, and eGFR. The study population exhibited a high prevalence of cardiovascular comorbidities, with 82.3% demonstrating cardiomegaly (mild-to-severe CTR) and 61.7% presenting with AAC. Bivariate analysis revealed a strong inverse correlation between eGFR and both CTR (r = −0.418, p < 0.001) and AAC score (r = −0.457, p < 0.001). Multivariate regression confirmed that both CTR (B = -1.738, p < 0.001) and AAC (B = -16.127, p < 0.001) were significant predictors of eGFR decline. Progressive CKD stages were associated with increased CTR (52.3% in Stage 1 vs. 58.7% in Stage 5) and greater AAC severity (0% advanced calcification in Stage 1 vs. 34% in Stage 5). Age, sex, and blood pressure did not show significant correlations with eGFR (p > 0.05). CTR and AAC are strongly associated with renal dysfunction, reinforcing the evidence of an interaction between cardiovascular pathology and CKD progression. These markers have the potential to serve as accessible biomarkers for identifying high-risk patients, thereby facilitating early intervention in resource-limited settings.

Incidental detection of Tietze syndrome with costochondritis: A case report Lister, Gilbert; Soekardi, Adi; Icksan, Aziza Ghanie
Jurnal Prima Medika Sains Vol. 7 No. 1 (2025): June
Publisher : Program Studi Magister Kesehatan Masyarakat Universitas Prima Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34012/jpms.v7i1.6815

Background: Tietze syndrome represents a rare and atypical source of anterior chest discomfort, distinguished by localized tenderness and non-suppurative swelling, typically centered around the 2nd or 3rd costal cartilages. Despite diligent investigation, the precise underlying causes of Tietze syndrome remain elusive. Case Report: We present a case of a 35 year old male patient with suspected Tietze syndrome with costochondritis. He came in with complaints of abdominal pain and frequent coughs. He has a history of ADPKD and thalassemia since age 12. Tietze syndrome was an incidental finding in this patient. A thorax scan showed multiple nodular and lobulated lesions in the medial mediastinum; additionally, an abnormal widening and flattening of the costochondral junction of the ribs bilaterally. The CT scan findings reveal notable deformities characterized by widened and irregularly shaped anterior rib masses spanning the 1st to the 4th ribs bilaterally. The USG scan of the thorax showed a hypogenic thickening of the costochondral junction with vascularization. Discussion: Tietze's syndrome presents a diagnostic challenge necessitating comprehensive imaging modalities for accurate diagnosis. Ultrasound imaging stands out as the primary approach, showcasing conspicuous soft tissue swelling indicative of the ongoing inflammatory process. While computed tomography often reveals subtle focal swellings or mild sclerosis in the affected joint. Conclusion: The clinical manifestations frequently encompass an abrupt onset of chest discomfort devoid of antecedent trauma, predominantly observed among younger cohorts with an otherwise clean bill of health. Ultrasound is an accurate and effective modality to diagnose Tietze syndrome. This disease is frequently associated with other comorbidities such as rheumetic and autoimmune disorders.

Incidental detection of achalasia in a patient with dyspnea Leslie, William; Soekardi, Adi; Icksan, Aziza Ghanie
Jurnal Prima Medika Sains Vol. 7 No. 1 (2025): June
Publisher : Program Studi Magister Kesehatan Masyarakat Universitas Prima Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34012/jpms.v7i1.6816

Background: The absence of progressive peristalsis in the esophageal body and aberrant relaxation of the LES are two characteristics of achalasia, which is a main motility disease of the esophageal body and lower esophageal sphincter (LES). The most typical signs of achalasia are dysphagia and recurrent regurgitation. Case report: We report a case of achalasia in a 54-year-old woman with the main complaint of dyspnea. Physical examination did not reveal any abnormalities. Chest x-ray results showed an enlarged upper mediastinal with air fluid level and superposition with the right border of the heart. The results of a chest computed tomography (CT) scan showed a dilated esophagus containing food material with air fluid levels. The patient then underwent an esophagostomy thoracotomy. Discussion: Primary achalasia is associated with inflammatory degeneration of the inhibitory ganglion cells of the esophageal myenteric plexus and LES. Dysphagia, regurgitation, problems swallowing food, chest pain, heartburn, and weight loss are the most common symptoms. Barium esophagram is the best diagnostic test for achalasia with "Rat Tail" or “bird’s beak” appearance. CT scan examination is not only less invasive and painful, but also has high sensitivity for achalasia. In addition, CT scan are useful for differentiating primary and secondary achalasia and for diagnosing complications of achalasia. Conclusion: Most cases of achalasia come with dysphagia, but some patients can come with respiratory problems or without complaints. CT scans can help identify achalasia in patients without complaints. Radiological examination plays an important role in detecting achalasia and reducing complications.

Chest CT as a Complement to RT-PCR to Confirm and Follow-up COVID-19 Patients Icksan, Aziza Ghanie; Hafiz, Muhammad; Harlivasari, Annisa Dian
Medicinus Vol. 9 No. 3 (2020): June 2020
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v8i1.3122

Background : The first case of COVID-19 in Indonesia was recorded in March 2020. Limitation of reverse-transcription polymerase chain reaction (RT-PCR) has put chest CT as an essential complementary tool in the diagnosis and follow up treatment for COVID-19. Literatures strongly suggested that High-Resolution Computed Tomography (HRCT) is essential in diagnosing typical symptoms of COVID-19 at the early phase of disease due to its superior sensitivity (97%) compared to chest x-ray (CXR).The two cases presented in this case study showed the crucial role of chest CT with HRCT to establish the working diagnosis and follow up COVID-19 patients as a complement to RT-PCR, currently deemed a gold standard.

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