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All Journal journal of internal medicine E-Jurnal Medika Udayana Jurnal Ilmiah Kedokteran Wijaya Kusuma JBN (Jurnal Bedah Nasional) ISM (Intisari Sains Medis) : Jurnal Kedokteran

Elysanti Dwi Martadiani

Departemen Radiologi Fakultas Kedokteran Universitas Udayana/RSUP Sanglah

Author-ID : 256406

Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Public Health

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Karakteristik temuan radiologis pada pasien low back pain di RSUP Sanglah Denpasar periode Maret 2016-Oktober 2017 Komang Mila Triana Sari; Elysanti Dwi Martadiani; Made Widhi Asih
Intisari Sains Medis Vol. 10 No. 1 (2019): (Available online 1 April 2019)
Publisher : DiscoverSys Inc.

Background: Low back pain (LBP) is a common problem in almost all parts of the world. It may cause disability and a huge social and economic burden in the community. Radiological examination is often necessary to help the doctor in evaluating LBP.Aim: The study aims to find out the radiological characteristics of LBP as a preventive effort against those case.Method: The study was descriptive cross-sectional design involved 65 LBP patients as study respondents in Sanglah General Hospital from March 2016-October 2017.Result: Characteristics of LBP patients are male patients and patients aged 50-59 years. Both are the most frequent sample which were found out in the study.Conclusion: The most common radiological findings in each examination modality are as follows: osteophytes on Radiographic examination, burst fracture, compression fracture and fractures of spinous process on CT scan, and spinal canal stenosis on MRI examination.

Temuan ultrasonografi pada kecurigaan klinis tumor payudara ganas di RSUP Sanglah periode januari â€“ desember 2015 I Kadek Riyandi Pranadiva Mardana; Elysanti Dwi Martadiani; Firman Parulian Sitanggang
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Background: cancer is the second leading cause of death in Indonesia, whereas 70% of patients have themselves examined at an advanced stage. One of the methodes to do breast cancer screening is by ultrasound examination to see each characteristic in several aspects (form, size, ecogenicity, components) found in the clinical suspicion of malignant cases.Methods: This study was conducted to see the importance of the role of ultrasonography in knowing the characteristics of malignant breast tumors in Sanglah General Hospital. This study was a cross-sectional descriptive (retrospective) at Sanglah General Hospital. Ultrasound examination data collection had been done from medical record of breast tumor patients (total sampling from January to December 2015). Data analysis study used digital data processing programs and presented in crosstabulating tables.Results: Total of 52 subjects showed 51 patients with normal characteristics of cutaneous tissue (98.1%), normal ecoparenkim in 47 patients (90.4%), 34 with no abnormalities characteristics of nodules/masses/cysts (65.4 %), 46 with normal ecogeneity characteristics (88.5%), regular lesion characteristics of shape/edge in 47 patients (90.4%), 37 with no abnormalities characteristics of the lesion (71.2%), 49 patients (94.2%) did not show any abnormalities characteristics of papillary calcification and retraction, 49 patients without abnormalities characteristics of papilla retraction, 47 patients (90.4%) without abnormalities characteristics of axilla glands.Conclusions: Ultrasonography characteristics result as the screening tool for malignant breast tumor in this study is able to asess some general features founded in malignant breast tumor cases.Â Â Latar Belakang: Kanker payudara merupakan keganasan penyebab mortalitas kedua tersering di Indonesia, dimana 70% dari penderita memeriksakan dirinya pada stadium lanjut. Salah satu cara skrining kanker payudara yaitu dengan pemeriksaan ultrasonografi. Setiap karakteristik hasil ultrasonografi memiliki tujuan penting untuk mengetahui bentuk, ukuran, ekogenitas, dan komponen lain yang dijumpai pada kecurigaan klinis tumor payudara ganas.Metode: Penelitian ini bertujuan melihat pentingnya peranan ultrasonografi dalam mengetahui karakteristik tumor payudara ganas di RSUP Sanglah. Penelitian ini merupakan penelitian deskriptif cross-sectional retrospektif di RSUP Sanglah. Prosedur penelitian berupa pengumpulan data pemeriksaan ultrasonograsi dari data rekam medis pasien tumor payudara (total sampling dari bulan Januari-Desember 2015). Analisis data menggunakan program pengolah data digital dan menyajikannya dalam tabel crosstabulating.Hasil: Total dari 52 orang subjek, 51 orang (98,1%) menunjukkan hasil normal pada karakteristik jaringan kutis, 47 orang (90,4%) dengan hasil normal pada karakteristik ekoparenkim, dari karakteristik nodul/massa/kista 34 orang pasien (65,4%) tidak tampak adanya kelainan, dari karakteristik ekogenitas 46 orang pasien (88,5%) menunjukan hasil normal, dari karakteristik bentuk/tepi lesi 47 orang pasien (90,4%) dengan bentuk/tepi lesi yang reguler, dari karakteristik batas lesi tidak ditemukan adanya kelainan pada 37 orang pasien (71,2%), dari karakteristik kalsifikasi dan retraksi papilla masing-masing 49 orang pasien (94,2%) tidak tampak adanya kelainan, dari karakteristik retraksi papilla 49 orang pasien tidak ditemukan adanya kelainan, dari karakteristik kelenjar aksila 47 orang pasien (90,4%) tidak ditemukan adanya kelainan.Simpulan: Karakteristik gambaran ultrasonografi sebagai skrining kasus tumor payudara ganas dalam penelitian ini mampu menilai beberapa temuan yang umum terjadi pada pasien tumor payudara ganas.

Maltracking Patella, Pseudo Patella Baja, dan Patellar Tilt sebagai faktor risiko terjadinya nyeri patellofemoral pasca total knee arthroplasty tanpa mengganti komponen patella di RSUP Sanglah, Bali, Indonesia Gusti Ngurah Putra Stanu; Putu Astawa; I Wayan Suryanto Dusak; Elysanti Dwi Martadiani; I Gede Eka Wiratnaya; I Gusti Ngurah Wien Aryana
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: Total Knee Artrhoplasty (TKA) is the final therapeutic choice for osteoarthritis (OA) if conservative therapy fails. However, some studies show that about 50% of patients undergoing TKA complain on anterior knee pain postoperatively. One of the most common causes of knee pain comes from the patellofemoral components. Some interesting potential risk factors needing investigations include patellar maltracking, pseudo patella baja, and patellar tilt. By knowing the relationship between these potential risk factors and patellofemoral pain after TKA, it is hoped that further modifications can be made intraoperatively to maximalize the functional outcomes of these patients.Methods: This is a Case Control study to investigate the factors affecting patellofemoral pain after TKA without patellar resurfacing, including patellar maltracking, pseudopatella baja, and patellar tilt, compared to those who don’t experience patellofemoral pain. The study was conducted at Sanglah Hospital, Denpasar, Bali in September-December 2019. Clinical and radiographic data were obtained secondarily from patient medical records.Results: Chi Square Test for Maltracking patella test showed a value of P = 0,000 (P <0.05), indicating a significant difference between the group with patellofemoral pain and those without. Chi Square Test for Pseudopatella Baja showed a value of P = 1,000 (P> 0.05), indicating no significant difference. While the Chi Square Test for Patellar Tilt showed a value of P = 0.045 (P <0.05), indicating a significant difference.Conclusion: Patellar maltracking and patellar tilt are proven to be risk factors for higher NRS values compared to those without, in post-TKA patients patellar resurfacing. Whereas Pseudopatella Baja was not proven to be a risk factor for higher NRS values. Latar Belakang: Total Knee Artrhoplasty (TKA) merupakan pilihan terapi tahap akhir dari osteoartritis (OA) lutut bila manajemen konservatif gagal. Walaupun demikian, beberapa studi menunjukan bahwa pasca operasi TKA, sekitar 50% pasien justru mengeluhkan nyeri pada bagian depan lutut. Salah satu penyebab tersering nyeri lutut pada pasien-pasien OA pasca TKA berasal dari komponen patellofemoral. Beberapa faktor risiko yang menarik untuk diteliti sebagai peyebab nyeri patellofemoral pasca TKA antara lain maltracking patella, pseudo patella baja, dan patellar tilt. Dengan mengetahui keterkaitan antara faktor-faktor risiko potensial tersebut dengan nyeri patellofemoral pasca TKA, diharapkan lebih lanjut dapat dilakukan modifikasi saat operasi guna mengurangi insiden nyeri patellofemoral pada pasien-pasien pasca TKA, sehingga dapat meningkatkan keluaran fungsional pasien-pasien tersebut.Metode: Penelitian ini merupakan penelitian Case Control untuk mengetahui faktor risiko terjadinya nyeri patellofemoral pasca TKA tanpa mengganti komponen patella pasien-pasien dengan OA lutut, terkait dengan yang memiliki faktor maltracking patella, pseudopatella baja, dan patellar tilt, dibandingkan dengan yang tidak memiliki faktor tersebut. Penelitian dilakukan di RSUP Sanglah, Denpasar, Bali selama bulan September-Desember 2019. Data klinis dan radiografis didapat dari data sekunder dari rekam medis penderita.Hasil: Uji Chi Square Maltracking patella menunjukkan nilai P = 0,000 ( P < 0,05), menandakan perbedaan yang signifikan antara kelompok yang nyeri dan tidak nyeri. Uji Chi Square Pseudopatella Baja menunjukkan nilai P = 1,000 ( P > 0,05), menandakan tidak adanya perbedaan yang signifikan. Sedangkan Uji Chi-square Patellar Tilt menunjukkan nilai P = 0,045 ( P < 0,05), menandakan perbedaan yang signifikan.Simpulan: Maltracking patella dan patellar tilt merupakan faktor risiko terhadap nilai NRS yang lebih tinggi dibandingkan tanpa maltracking patella pada pasien-pasien pasca-TKA tanpa mengganti komponen patella. Sedangkan Pseudopatella Baja tidak terbukti sebagai faktor risiko terhadap nilai NRS yang lebih tinggi dibandingkan tanpa pseudopatella Baja pada pasien-pasien pasca-TKA tanpa mengganti komponen patella.

Pencitraan pada pankreolithiasis dengan pankreatitis kronis: laporan kasus Indira Prawita Martini; Nyoman Srie Laksminingsih; Elysanti Dwi Martadiani
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: Pancreolithiasis or pancreatic calculus is a rare case. Men suffer more than women with a ratio of 2-3:1 and have an incidence of 1-8:100.000. Pancretolithiasis itself is a sequela of chronic pancreatitis. Accompanied by non-specific complaints, epigastric abdominal pain that radiates to the back to the left shoulder and nausea, vomiting which causes weight loss and malnutrition. Radiological examination can help the clinician in. establish a diagnosis where the laboratory results are also not specific enough to diagnose chronic pancreatitis. The aim of this report is to determine the radiological features of pancreolithiasis accompanied by chronic pancreatitis.Case: A 54-year-old woman with complaints of pain in the epigastric region for approximately 3 months, accompanied by nausea and vomiting, especially after eating which resulted in weight loss of approximately 10 kilograms. In laboratory tests, an increase in total cholesterol, LDH and hyperkalemia was found. There is no increase in amylase and lipase and hepatic function. On plain abdominal radiograph, ultrasound and CT scan, it is found that there is a stone image accompanied by imaging of chronic pancreatitis.Conclusion: Pancreatic calculus is a rare condition. More common in male gender, patients with pancreolithiasis have non-specific discharge. Alcohol use is said to be the biggest factor in pancreolithiasis. On plain abdominal radiograph, ultrasound and CT scan can reveal the presence of stones in the pancreas and the presence or absence of involvement of the pancreatic parenchyma.

Brittle bone brothers: osteogenesis imperfecta conventional serial case Marsha Ruthy Darmawan; Elysanti Dwi Martadiani
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: Osteogenesis Imperfecta (OI) is a heredity connective tissue disorder due to COL1A1/2 gene mutation, causing a defect in encoding proteins to metabolize collagen. One of OI’s manifestations to musculoskeletal is bone incompetence, hence the name Brittle bone disease. We report three cases of OI type IV in adults with pathognomonic radiology findings.Case Presentation: In Case 1, a 40-year-old Indonesian male came to the hospital with small stature and unsuited with his age. Conventional radiology examination found OI on all four extremities, anterior dislocation of left shoulder, and old fracture with an acute angle in the left radial shaft. In Case 2, a 41-year-old Indonesian male came to the hospital with short stature, causing limitation to his activities, and he confessed always to be shorter than people his age. Radiology evaluation suggests an OI in bilateral superior and inferior extremities, old fractures in the right humeral shaft also the left clavicle, acute angles right radius-ulna shaft, and osteoporosis in all visualized bones. In addition, in Case 3, a 42-year-old Indonesian male came to the hospital with short stature and pain within his bones, causing limitation to his activity. Conventional radiology imaging shows bilateral superior and inferior extremities, old fracture in the medial third of the left humerus and bilateral femur, acute-angled bilateral antebrachial-femur-cruris, and osteoporosisConclusion: Based on OI categorization, only type I and IV can live to adulthood, and the same type of OI can be found in siblings. Conventional radiology imaging provides a great help in diagnosing OI.

Gambaran radiologi lesi litik pada manus: serial kasus Jessica Harlan; Elysanti Dwi Martadiani; Made Widhi Asih; I Wayan Juli Sumadi
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Background: Lytic lesion of the hand has been challenging in making the differential diagnoses. Tumor and tumor-like lesions present with a wide spectrum of radiological changes.Cases: The first patient is a 17 years old male presents with a painless lump in the left 5th finger, suggested as benign bone tumor. The second patient is a 28 years old male presents with a painful lump in the left 3rd finger,suggested as close fracture of the left metacarpal of the hand. The third patient is a 11 years old male presents with a painless lump and open wound in the right 2nd finger,suggested as aggressive bone tumor. First patient‘s hand radiographs reveal expansile lytic lesions with narrow transitional zone, endosteal scaloping, ring and arc calcification, no perisoteal reaction, no cortical destruction in metadiaphysis of 5th metacarpal and proximal phalanx of the left hand, suggested as primary benign bone tumor, suggested enchondroma. Histomorphology result suggested as enchondromatosis. Second patient‘s hand radiographs reveal expansile lytic lesion with narrow transitional zone and cortical destruction, no periosteal reaction, no calcification in epiphysis to diaphysis of 3rd proximal phalanx of the left hand, suggested as primary benign bone tumor, suggested giant cell tumor. Histomorphology result suggested as benign giant cell tumors of the bone. Third patient’s hand radiographs reveal fusiform expansile lytic lesion with narrow transitional zone causes enlargement of diaphysis with cortical destruction and soft tissue mass, no periosteal reaction, no calcification in 2nd proximal phalanx of right hand, suggested as tuberculous dactylitis, suggested non tuberculous osteomyelitis. Histomorphology result suggested as tuberculous process.Conclusion: Imaging and histomorphology play an important role in differentiating tumor and tumor-like lesions in bone. Recognition of imaging appearance of these lesions may help clinicians make a decision for the treatment. Latar Belakang: Lesi osteolitik pada manus menjadi tantangan dalam membuat diagnosis banding. Tumor dan lesi yang menyerupai memiliki gambaran radiologi beragam.Kasus: Pasien pertama laki-laki usia 17 tahun dengan keluhan benjolan yang tidak nyeri pada jari ke 5 tangan kiri dengan kecurigaan tumor tulang jinak. Pasien kedua laki-laki usia 28 tahun dengan keluhan benjolan yang nyeri pada jari ke 3 tangan kiri dengan kecurigaan fraktur tertutup pada metacarpal tangan kiri. Pasien ketiga laki-laki usia 11 tahun dengan keluhan benjolan disertai luka terbuka pada jari ke 2 tangan kanan dengan kecurigaan tumor tulang agresif. Radiografi manus pasien pertama mengesankan lesi litik ekspansil dengan narrow transitional zone pada metadiafisis metacarpal digiti V dan phalang proksimal digiti V manus kiri dengan endosteal scalopping, tidak tampak reaksi perisoteal maupun destruksi korteks, matriks kalsifikasi ring and arc yang mengesankan tumor tulang primer jinak, mengesankan enchondroma. Histomorfologi sesuai gambaran enchondromatosis. Radiografi manus pasien kedua mengesankan lesi litik ekspansil dengan narrow transitional zone yang menyebabkan destruksi korteks pada epifisis hingga diafisis phalang proksimal digiti III manus kiri dengan keterlibatan jaringan lunak, tidak tampak matriks kalsifikasi maupun reaksi periosteal yang mengesankan gambaran giant cell tumor. Histomorfologi sesuai gambaran giant cell tumor tulang jinak. Radiografi manus pasien ketiga mengesankan lesi litik ekspansil fusiform dengan narrow trazitional zone yang menyebabkan pelebaran diafisis dengan destruksi korteks dan keterlibatan jaringan lunak pada phalang proksimal digiti II manus kanan, tidak tampak matriks kalsifikasi maupun reaksi periosteal yang mengesankan suatu daktilitis tuberkulosis dengan diagnosis banding osteomyelitis non tuberkulosis. Histomorfologi sesuai gambaran tuberculosis. Simpulan: Pencitraan dan histomorfologi memainkan peran penting dalam membedakan tumor dan lesi yang menyerupai tumor pada tulang. Mengenali lesi ini sangat penting karena membantu klinisi untuk menentukan terapi.

Atipikal intraoseus hemangioma: laporan kasus Pande Putu Bagus Premana; Elysanti Dwi Martadiani; Ni Nyoman Margiani; I Wayan Juli Sumadi
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Introduction: Atypical hemangioma is rarely found benign neoplasm which frequently involves the vertebrae and craniofacial bones. Meanwhile, soft tissue hemangioma is a benign vascular neoplasm commonly encountered. When it occurs in long bones, it is usually found at diaphysis and meta-diaphysis. Intraosseous hemangioma can occur at any age and is usually asymptomatic, whereas soft tissue hemangioma is more frequent in women compared to men.Case report: A 26-year-old woman had a complained about pain on the left thigh over the past 10 years, that worsened for the past few months. Her growth and development was normal. Five years before admission, she had fallen while walked, but no history of having surgery. Femur radiograph showed expansile lytic lesion with narrow transitional zone accompanied by sclerotic and ground glass apperance on left femoral diaphysis and soft tissue swelling that contain calcification. CT scan revealed well defined lobulated solid soft tissue mass with calcification within the mass. it contain dilated and turtous vascular component, causing expansile lytic lesion and cortical destruction.Conclusion: Soft tissue Hemangioma is often found to have a higher occurrence in women compared to men. Unlike hemangioma in the axial bone, the diagnosis of hemangioma in the appendicular bone is more challenging due to rare cases and non-specific radiological features. Intraosseous hemangioma can provide varied radiological features and must be included in comparative diagnosis of osteolytic and expansile lesions. Pendahuluan: Hemangioma atipikal jarang merupakan neoplasma jinak yang jarang ditemukan danering melibatkan tulang vertebra dan kraniofasial. Sedangkan hemangioma jaringan lunak merupakan neoplasma vaskuler jinak yang biasa dijumpai. Ketika terjadi pada tulang panjang, biasanya ditemukan di diafisis dan meta-diafisis. Hemangioma intraoseus dapat terjadi pada semua usia dan biasanya asimtomatik, sedangkan hemangioma jaringan lunak lebih sering terjadi pada wanita dibandingkan pria. Laporan kasus ini akan mendeskripsikan gambaran hemangioma intraoseus atipikal pada seorang laki-laki dewasaLaporan Kasus: Seorang wanita berusia 26 tahun memiliki keluhan tentang nyeri pada paha kiri selama 10 tahun terakhir, yang memburuk selama beberapa bulan terakhir. Pertumbuhan dan perkembangannya normal. Lima tahun sebelum masuk rumah sakit, pernah mengalami kondisi jatuh berjalan, tapi tidak ada riwayat menjalani operasi. Radiografi femur menunjukkan lesi litik yang meluas dengan zona transisi yang sempit disertai dengan munculnya sklerotik dan ground glass pada diafisis femoralis kiri dan pembengkakan jaringan lunak yang mengandung kalsifikasi. CT-scan menunjukkan massa jaringan lunak padat berlobus yang terdefinisi dengan baik dengan kalsifikasi di dalam massa. itu mengandung komponen pembuluh darah melebar dan kura-kura, menyebabkan lesi litik yang meluas dan kerusakan kortikal.Simpulan: Hemangioma jaringan lunak sering ditemukan memiliki kejadian yang lebih tinggi pada wanita dibandingkan pria. Tidak seperti hemangioma pada tulang aksial, diagnosis hemangioma pada tulang apendikuler lebih menantang karena kasus yang jarang terjadi dan gambaran radiologis yang tidak spesifik. Hemangioma intraoseus dapat memberikan gambaran radiologis yang bervariasi dan harus dimasukkan dalam diagnosis komparatif lesi osteolitik dan lesi ekspansil.

Pria 80 tahun dengan tumor ganas dinding dada: laporan kasus Raissa Andi Soekrisno; Dewa Gde Mahiswara Sudiatmika; Elysanti Dwi Martadiani; Firman Parulian Sitanggang; Herman Suputra
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Background: Malignant tumors that form in bone, soft tissue, or cartilage, are called sarcomas. Symptoms of these tumors vary, and may include shortness of breath, chest pain, and swelling around the tumor. Imaging such as X-rays and CT scans can be helpful, although imaging features of the few malignant chest wall tumors that are less specific, knowledge of the typical radiographic manifestations of these tumors can often make it easier for experts to differentiate between benign and malignant tumors and help lead to a more specific diagnosis.Case presentation: An 80-year-old man complains of a lump in the right chest. The results of laboratory tests showed anemia, decreased kidney function, and hypercalcemia. The CT scan of the thorax with contrast showed a solid mass in the right pleural cavity infiltrating the surrounding chest wall muscles, bilateral pneumonia, and osteolytic lesions on the spine suspected of being a metastatic process or spreading malignancy. The results of the biopsy showed a diffuse morphological appearance of immature plasma cells with an approach to the diagnosis of cutaneous infiltration plasma cell myeloma with a differential diagnosis of plasmablastic lymphoma.Conclusion: The results of X-ray imaging and CT scan of the thorax help narrow the differential diagnosis, where there is an image of a tumor on the chest wall with destruction of the surrounding bone and soft tissue and an image of infiltration into the pleura accompanied by multiple osteolytic images of the vertebrae. Assisted by a biopsy (anatomical pathology), the closest diagnosis in this patient is plasma cell myeloma chest wall. Latar Belakang: Tumor ganas yang terbentuk pada tulang, jaringan lunak, atau kartilago disebut sarcoma. Gejala dari tumor ini bervariasi, dapat berupa sesak nafas, nyeri dada, dan pembengkakan pada sekitar tumor. Pencitraan seperti rontgen dan CT scan dapat membantu, walaupun gambaran pencitraan dari beberapa tumor ganas dinding dada kurang spesifik, pengetahuan tentang manifestasi tipikal pada radilogi dari berbagai tumor ini seringkali dapat memudahkan para ahli untuk membedakan jenis tumor jinak dan ganas dan membantu mengarahkan diagnosis yang lebih spesifik.Kasus: Seorang laki – laki berusia 80 tahun dengan keluhan benjolan di dada sebelah kanan. Hasil pemeriksaan laboratorium didapatkan hasil anemia, penurunan fungsi ginjal, dan hiperkalsemia. Hasil CT Scan thorax dengan kontras menunjukkan adanya massa solid pada cavum pleura kanan yang menginfiltrasi otot dinding dada di sekitarnya, pneumonia bilateral, serta lesi osteolitik pada tulang belakang yang dicurigai sebagai suatu proses metastase atau penyebaran keganasan. Hasil biopsi menunjukkan gambaran morfologi sebaran difus sel plasma imatur-matur dengan pendekatan pada diagnosis cutaneus infiltration plasma cell myeloma dengan diagnosis banding plasmablastic lymphoma.Simpulan: Hasil pencitraan rontgen dan CT scan thorax membantu menyempitkan diagnosis banding, di mana terdapat gambaran tumor pada dinding dada dengan destruksi tulang dan jaringan lunak di sekitarnya serta gambaran infiltrasi ke pleura disertai gambaran osteolitik multipel pada vertebrae. Dibantu dengan pemeriksaan biopsi (patologi anatomi) maka diagnosis yang paling mendekati pada pasien ini adalah plasma cell myeloma dinding dada

Co-Authors Anastasia Tjan Daniel Setiawan Lay Dewa Gede Mahiswara Suadiatmika Eka Wiratnaya Ency Eveline Firman Parulian Sitanggang Firman Parulian Sitanggang Firman Parulian Sitanggang Gusti Ngurah Putra Stanu Herman Suputra I Gde Raka Widiana I Gusti Agung Gede Mahendra Wijaya I Gusti Ngurah Wien Aryana I Kadek Riyandi Pranadiva Mardana I Made Dwijaputra Ayusta I Putu Ary Wismayana I Wayan Gede Artawan Eka Putra I Wayan Juli Sumadi I Wayan Suryanto Dusak Indira Prawita Martini Inez Kartika Jessica Christy Jessica Harlan Jodi S Loekman Kadek Intan Jelita Ketut Suwitra Komang Mila Triana Sari Lisna Astuti Made Widhi Asih Marsha Ruthy Darmawan Ni Nyoman Margiani Nyoma Sutarka Nyoman Margian Nyoman Srie Laksminingsih Pande Putu Bagus Premana Pande Putu Yuli Anandasari Patriawan, Putu Putu Astawa Putu Diah Vedayanti Putu Herry Juniada Raissa Andi Soekrisno Tjan, Anastasia Velisia Putri Natalie Vennesia Stephany Wayan Sudhana Yenny Kandarini Yosep Made Pius Cardia

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Journal : ISM (Intisari Sains Medis) : Jurnal Kedokteran