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