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
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
 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
 Air fluid level di
lambung

Air fluid level sedikit

pada usus kecil
Usus Besar
Perifer
Haustra: plika semi lunaris
Diameter < 6 cm, cecum <9 cm

Usus Kecil
Central
Valvulae: plika sirkularis
Diameternya < 3 cm
Supine (paling sering)
Prone
Left Lateral Dicubitus(LLD)
Erect atau semi erect
Pada kasus obstruktivus biasanya
digunakan proyeksi > 1 atau cukup 1
proyeksi erect dengan sinar horisontal
Untuk melihat :
Pola udara dalam usus
Kalsifikasi
Soft tissue mass
Tulang
Untuk melihat :
Udara dalam rectum/
sigmoid
Udara dalam colon asenden
dan desenden
 Untuk melihat :
• Free-air

• Air fluid level

Dapat digantikan
dengan Proyeksi Left
Lateral
Decubitus(LLD)
 Udara bebas intraperitoneum atau ekstraluminer
Causa :
- Robeknya dinding saluran cerna (trauma, iatrogenik,
kelainan di saluran cerna),
- Tidakan melalui permukaan peritoneal (transperitoneal
manipulasi, endoscopic biopsy, abdominal needle biopsy)
- Intraperitoneal ( gas forming peritonitis, ruptur abses )
Gambaran Radiologi :
Cupula sign
Foot ball sign
Double wall sign /Rigler sign
Ligamentum falciforum sign
Umbilical sign
Urachus sign
 Biasanya menggunakan 2 proyeksi foto :
- FPA supine

- X Thorak erect atau left lateral decubitus

Cupula sign
Cupula sign
 Air on both sides of bowel wall
– Rigler’s Sign

Free Intraperitoneal Air

Umbilical sign
Urachus sign
Falciform Ligament
Sign

Football sign
Fungsional Ileus :
Localized (sentinel loop)
Generalized adynamic ileus
Mechanical Obstructions :
Small bowel obstructions(SBO)
Large bowel obstructions (LBO)
 Air in Rectum/ Air in small bowel Air in large bowel
Sigmoid

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

sigmoid

Generalized Ileus + Multiple distended Distended

loop

SBO - Multiple dilated loop -

LBO - None-unless Ileocecal Dilated

valve incompetent
1 atau 2 loop usus kecil atau usus besar
yang dilatasi persisten
Udara dalam rectum / sigmoid (+)
 Prone
Supine
Cholecystitis Pancreatitis
Ulcer

Diverticulitis
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
 Erect
Supine

Generalized Adynamic Ileus

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
SBO
Coil spring
Dilatasi colon
Udara minimal terutama di rectum
Udara di usus kecil minimal/ (-) jika katub
ileocecal competent
Jika katub ileocecal incompetent maka akan
terjadi decompresi udara dari colon ke usus
kecil
Causa : tumor, volvulus, hernia divertikulitis,
intususepsi
Supine Prone
Supine Prone
 "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 pergerakan
organ.
Dapat memeriksa lapisan dalam dan luar organ.
Menggunakan kontras barium (terbanyak)
Curiga perforasi  kontras yang larut dalam air.
Pengetahuan teknik & pengenalan gambaran
radiologis  dx.
Barium Swallow

Generally both single contrast & air

contrast is performed.
Using flurouscopy & allow for the
assesment os. Motilithy, contour,
obstructions & abnormalitilies of the lumen.
BARIUM SWALLOW AIR CONTRAST

AP LAT
BARIUM SWALLOW BARIUM SWALLOW
SINGLE CONTRAST DOUBLE CONTRAST
 ABNORMAL CONTOUR

ABNORMAL MOTILITY
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

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
DIVERTIKEL ESOFAGUS
ESOFAGUS BARRETT
COLON IN LOOP

- Single contrast
- Double contrast
VIRTUAL CT-COLONOGRAPHY
ORGAN VISERA
 ORGANS

• Liver
• Gallbladder
• Pancreas
• Spleen
• Stomach
• Small intestine
• Large Intestine
Organ  plain radiograph  hard to see
• CT
• MRI
• ULTRASOUND
Contras ?
•Oral
- Dilute iodine
- Dilute barium

•Intravenous
- Iodine ( Non-ionic )
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