BEKTI SAFARINI

FAKULTAS KEDOKTERAN UNISSULA SEMARANG

IMAGING THE ABDOMEN

Plain Film

Contras studies

CT

MRI

Ultrasound

Nuclear Scintigraphy

FPA

A number of indications for requesting abdominal

films:

Bowel obstruction - abnormal gas pattern

Free air - abnormal gas pattern

Abscess - abnormal gas pattern

Calculi or other abnormal intra-abdominal

calcifications

Radiopaque foreign bodies

FPA : Apa saja yang dinilai?

Preperitoneal fat line

Psoas line

Pola udara dalam saluran cerna

Adanya udara bebas

Soft tissue mass(+)/(-)

Kalsifikasi (+) / (-)

Tulang

Lambung : Udara selalu (+)

Usus kecil : terlihat 2-3 loop usus, tak ada

distensi.Diameter < 3cm

Rectum dan Sigmoid : selalu terlihat

POLA NORMAL UDARA DALAM SALURAN PENCERNAAN

Udara dalam

lambung

Udara terlihat pada

bbrpa loop usus

halus

Udara dalam Rectum

& Sigmoid

Lambung : selalu (+), kecuali proyeksi

supine

Usus kecil: 2-3 fluid level masih normal

Usus besar : 2-5 fluid level masih normal

NORMAL FLUID LEVEL

Air fluid level di

lambung

Air fluid level

sedikit pada usus

kecil

Usus BesarPeriferHaustra: plika semi lunarisDiameter < 6 cm, cecum <9 cm

Usus KecilCentralValvulae: plika sirkularisDiameternya < 3 cm

USUS BESAR VS USUS KECIL

Supine (paling sering)

Prone

Left Lateral Dicubitus(LLD)

Erect atau semi erect

Pada kasus obstruktivus biasanya digunakanproyeksi > 1 atau cukup 1 proyeksi erect dengansinar horisontal

PROYEKSI FPA

Untuk melihat :

• Pola udara dalam usus

• Kalsifikasi

• Soft tissue mass

• Tulang

FPA SUPINE

Untuk melihat :

• Udara dalam rectum/

sigmoid

• Udara dalam colon asenden

dan desenden

FPA PRONE

Untuk melihat :

• Free-air

• Air fluid level

Dapat digantikan

dengan Proyeksi Left

Lateral Decubitus(LLD)

FPA ERECT

PNEUMOPERITONEUM

Udara bebas intraperitoneum atau ekstraluminer

Causa :

- Robeknya dinding saluran cerna (trauma, iatrogenik, kelainan di saluran cerna),

- Tidakan melalui permukaan peritoneal (transperitonealmanipulasi, endoscopic biopsy, abdominal needle biopsy)

- Intraperitoneal ( gas forming peritonitis, ruptur abses )

PNEUMOPERITONEUM

Gambaran Radiologi :

Cupula sign

Foot ball sign

Double wall sign /Rigler sign

Ligamentum falciforum sign

Umbilical sign

Urachus sign

PNEUMOPERITONEUM

Biasanya menggunakan 2 proyeksi foto :

- FPA supine

- X Thorak erect atau left lateral decubitus

PROYEKSI FOTO

Cupula sign

Cupula sign

Free Intraperitoneal Air

Air on both sides of bowel

wall – Rigler’s Sign

Umbilical sign

Urachus sign

Free Intraperitoneal Air

Falciform Ligament

Sign

Football sign

ABNORMALITAS POLA UDARA DALAM USUS

Fungsional Ileus :

Localized (sentinel loop)

Generalized adynamic ileus

Mechanical Obstructions :

Small bowel obstructions(SBO)

Large bowel obstructions (LBO)

ABNORMALITAS POLA UDARA

Air in Rectum/Sigmoid

Air in small bowel Air in large bowel

Localized Ileus + 2-3 distended loops Air in rectum/ sigmoid

Generalized Ileus + Multiple distended loop Distended

SBO - Multiple dilated loop -

LBO - None-unless Ileocecalvalve incompetent

Dilated

1 atau 2 loop usus kecil atau usus besar

yang dilatasi persisten

Udara dalam rectum / sigmoid (+)

LOCALIZED ILEUS ( Sentinel Loop )

Supine

Prone

Pancreatitis

Ulcer

Diverticulitis

Cholecystitis

Appendicitis

Ulcer

Ureteral calculus

Sentinel Loops

Gambaran udara dalam usus kecil dan

usus besar yang dilatasi

Udara dalam rectum/ sigmoid (+)

Multipel air fluid level panjang

Sering terjadi pada pasien post operasi

GENERALIZED ILEUS

Generalized Adynamic Ileus

SupineErect

Dilatasi usus kecil

Gambaran coil spring dan herring bone

Udara dalam colon minimal, terutama di

daerah rectum

Multipel air fluid level pendek

Causa : Adhesi, volvulus, gallstone ileus.

intusupsesi

SMALL BOWEL OBSTRUCTIONS

SBO

Coil spring

Dilatasi colon

Udara minimal terutama di rectum

Udara di usus kecil minimal/ (-) jika katub ileocecalcompetent

Jika katub ileocecal incompetent maka akan terjadidecompresi udara dari colon ke usus kecil

Causa : tumor, volvulus, hernia divertikulitis, intususepsi

LARGE BOWEL OBSTRUCTIONS

Supine Prone

ProneSupine

"Normal" calcifications

Bones are the only normal calcified structures.

Many other calcifications will be seen that have no clinical significance

Vascular-veins of the pelvis (phleboliths)

Costal cartilage

Lymph nodes

Granulomas

Injection sites

ABNORMAL

CALCIFICATIONS

URETEROLITHIASIS

UTERINE FIBROID

APPENDICOLITH

CONTRAST STUDY UPPER GI TRACT

Pemeriksaan radiologi pada esofagus, lambung &duodenum (batas distal : ligamentum Treitz).

Dapat memeriksa fungsi, struktur dan pergerakanorgan.

Dapat memeriksa lapisan dalam dan luar organ.

Menggunakan kontras barium (terbanyak)

Curiga perforasi kontras yang larut dalam air.

Pengetahuan teknik & pengenalan gambaranradiologis dx.

PEMERIKSAAN UPPER GI TRACT

Barium Swallow

Generally both single contrast & air

contrast is performed.

Using flurouscopy & allow for the

assesment os. Motilithy, contour,

obstructions & abnormalitilies of the lumen.

PEMERIKSAAN UPPER GI TRACT

BARIUM SWALLOW AIR CONTRAST

AP LAT

BARIUM SWALLOW

SINGLE CONTRAST

BARIUM SWALLOW

DOUBLE CONTRAST

ABNORMAL MOTILITY

ABNORMAL CONTOUR

Esophagram weak nonpropulsive peristaltic waves below level of

cricopharyngeus will persist even after LES has been fixed incomplete

emptying of esophagus even in upright position "rat tail" or "beak"

appearance--gradual smooth tapering of distal esophagus extends for 1 to

3 cm Hurst Phenomenon--temporary transit through cardia provoked by

hydrostatic pressure of barium column reaching above a critical level

Plain film dilated and tortuous esophagus, with amounts of retained food

and fluid aspiration of material leads to chronic interstitial pulmonary

disease stomach bubble is small or absent

AKALASIA

AKALASIA

VARISES ESOFAGUS

ESOFAGITIS PEPTIK

KARCINOMA ESOFAGUS

DIVERTIKEL ESOFAGUS

ESOFAGUS BARRETT

BARIUM FOLLOW THROUGH

COLON IN LOOP

- Single contrast

- Double contrast

BARIUM ENEMA

Double-contrast barium enema showing an “apple core” lesion involving the sigmoid colon

CA COLON

VIRTUAL CT-COLONOGRAPHY

CT COLONOGRAPHY

ORGAN VISERA

ORGANS

• Liver

• Gallbladder

• Pancreas

• Spleen

• Stomach

• Small intestine

• Large Intestine

Organ plain radiograph hard to see

• CT

• MRI

• ULTRASOUND

AXIAL IMAGING

Contras ?

• Oral

- Dilute iodine

- Dilute barium

• Intravenous

- Iodine ( Non-ionic )

COMPUTED TOMOGRAPHY

LIVER CT

LIVER MRI

LIVER ULTRASOUND

GALBLADDER CT

GALBLADDER US

MR CHOLANGIOPANCREATOGRAM(MRCP)

A cruise Through the Abdomen on a CT Scan

• In the past, patients with abdominal problem would first a

plain radiograph.

• Then perhaps an upper GI series ( UGI ) and / or barium

enema ( BE )

• Today, it is very common to obtain a CT

- Shown more anatomic detail than X-Rays.

- Much of the same informations as UGI