http://www.radcharts.org/Vascular/Vascular.

html

Thoraks:

CTR > 50% jantung kesan membesar kekiri, apex tertanam,

aorta elongasi kalsifikasi dan mediastinum tak melebar
trakea dan hilus baik
Paru tak tampak infiltrat / nodul
Diafragma dan sinus baik

Kesimpulan:
- Kardiomegali, aorta elongasi kalsifikasi.
- Pulmo tak tampak kelainan radiologis.

Terpasang kateter double lumen / CVP dengan ujung pada proyeksi vena cava superior

Prostat : volume cc. Kontur reguler. Tidak tampak lesi fokal/kalsifikasi.

Uterus : besar dan bentuk baik, tidak tampak lesi fokal

Adneksa kanan-kiri : tidak tampak lesi padat / kistik

McBurney : appendiks sulit dinilai karena tertutup bayangan udara usus yang prominen, namun
kemungkinan adanya appendiksitis belum dapat disingkirkan.

USG ABDOMEN BAWAH

Buli-buli: besar dan bentuk baik, dinding tidak menebal, tak tampak batu / massa
Prostat : ukuran x x cm. Volume cc. Kontur reguler, tidak tampak menonjol ke buli. Tidak tampak
lesi fokal/kalsifikasi.
Volume sisa urine pasca miksi sebanyak cc.

Kesan: Hipertrofi prostat dengan volume sisa urine pasca miksi sebanyak cc.

USG GINJAL:

Ginjal kanan: Ukuran , 10,0 x 4,5 cm, diferensiasi korteks dan medula baik, sistim pelviokalises tak
melebar, tak tampak batu / massa kistik / padat.

Ginjal kiri : Ukuran , 10,0 x 4,5 cm, diferensiasi korteks dan medula baik, sistim pelviokalises tak
melebar, tak tampak batu / massa kistik / padat.

Kesan:
USG doppler tungkai kanan/kiri :

Sistem arteri :
- kaliber pembuluh darah baik.
- tunika intima media reguler tidak menebal.
- plaque tidak tervisualisasi.
- velocity aliran darah baik.
- turtous (-)
- morfologi doppler umumnya trifasik.

Sistem vena :
- compress US kolaps sempurna pada level femoral-politeal, tidak tampak lesi intraluminer.
- tidak tampak aliran retrograde pada valsava manuver.

Kesimpulan : Tidak tampak kelainan pada doppler arteri dan vena tungkai kanan/kiri saat ini.

Bone survey:

Tulang kalvaria: Tabula eksterna, diploe dan tabula interna intak, tak tampak lesi destruksi litik /
blastik, tak tampak fraktur linier / impresi
Tulang tulang costa : tak tampak lesi destruksi litik /blastik.
Tulang tulang panjang: korteks menipis, rabekula prominent, tak tampak lesi destruksi litik /. blastik.
Tulang tulang vertebrae: struktur tulang porotik, alignment baik, tak tampak lesi litik / blastik pada
korpus dan pedikels .
Tulang tulang pelvis: tak tampak lesi litik / blastik .

Kesimpulan: Tak tampak tanda metastasis pada tulang tulang tersebut diatas.

BNO:

Preperitoneal fat line kanan-kiri baik

Distribusi udara usus sampai ke pelvis minor dengan debris fecal material prominen
Tidak tampak bayangan radioopak di proyeksi traktus urinarius.
Kontur ginjal dan psoas line baik.
Tulang-tulang intak.

Kesan : Tidak tampak urolithiasis radioopak.

BNO-IVP
BNO:
Distribusi udara usus sampai pelvis minor
Tak tampak adanya bayangan opak di proyeksi traktus urinarius
Kontur ginjal dan psoas line baik
Tulang-tulang baik

IVP:
Fungsi sekresi kedua ginjal baik.
Sistim pelviokalises ginjal kanan dan kiri baik, tak tampak pelebaran
drainage kontras pada kedua ureter lancar, tak tampak bendungan
Buli-buli: besar dan bentuk baikk, tak tampak indentasis / batu
Sisa urine pasca miksi minimal.

Kesimpulan: Tak tampak urolithiasis / bendungan

CT Scan Urografi:

Ginjal kanan:
Ukuran dan bentuk baik, kontur reguler, tebal korteks normal, sistim pelviokalises tak melebar, tak
tampak batu / massa kistik / padat, flow urine di ureter kanan lancar, tak tampak bendungan, tak
tampak batu

Ginjal kiri:
Ukuran dan bentuk baik, kontur reguler, tebal korteks normal, sistim pelviokalises tak melebar, tak
tampak batu / massa kistik / padat, flow urine di ureter kiri lancar, tak tampak bendungan, tak tampak
batu

Buli: ukuran dan bentuk baik, dinding tak menebal, tak tampak batu / massa

Kesimpulan:

Genu bilateral :

Kedudukkan tulang-tulang baik, tidak tampak subluksasi / dislokasi

Tak tampak fraktur / destruksi
Penyempitan sela sendi femorotibial bilateral sisi medial.
Spur di condylus medial dan lateral os femur dan tibia, eminensi medial lateral bilateral, dan os patella
bilateral.
Kalsifikasi jaringan lunak poplitea (fabella) bilateral.

Kesimpulan: OA genu bilateral.

Thoraks :

CTR < 50% , aorta dan mediastinum tak melebar

trakea dan hilus baik
Paru tak tampak infiltrat
Diafragma dan sinus baik

Kesimpulan:
Cor dan pulmo tak tampak kelainan radiologis.

Lumbosakral:

Alignment baik tak tampak listesis

kelengkungan berkurang kesan melurus
Densitas tulang menurun dengan trabekulasi prominen
Tak tampak fraktur / destruksi pada corpus / pedikels.
Penyempitan diskus L5-S1.
Spur anterolateral lumbalis.

Kesan; Straight (muscle spasme?) dan spondiloarthrosis lumbalis dengan penyempitan diskus L5-S1.

TULANG :

Alignment baik, tidak tampak subluksasi / dislokasi.

Densitas tulang baik, tidak tampak fraktur / destruksi.
Tidak tampak spur formation.
Celah sendi tidak menyempit / melebar.
Jaringan lunak baik.

Kesan : Tidak tampak kelainan radiologis pada

Cholangiografi:

Dimasukkan kontras melalui T-Tube: tampak kontras lancar memasuki duktus choledokus, duktus
hepatikus kanan kiri, hepatikus komunis, kaliber dan kontur baik tak tampak filling defect maupun
additional shadow, tak tampak tanda bendungan, terlihat spill ke duodenum.
Kesimpulan: Tak tampak tanda bendungan pada sistim bilier saat ini

USG TENDON ACHILLES

Umur 18-30 th (diameter 6,3 mm +/- 0,5 mm)

Umur > 30 th (diameter 6,9 +/- 1,0 mm)
Pada posisi transversal berbentuk ovoid.
http://www.diva-portal.org/smash/get/diva2:140899/FULLTEXT01.pdf

USG GINJAL dan DOPPLER GINJAL TRANSPLANTASI :

Ginjal kanan: Ukuran , 6,7 x 3,9 cm, korteks menipis, difrensiasi korteks dan medula suram dan
memadat, sistim
pelviokalises tak melebar, tak tampak batu / massa kistik / padat.
Ginjal kiri : Ukuran , 9,6 x 4,2 cm, korteks menipis, difrensiasi korteks dan medula suram dan
memadat, sistim
pelviokalises tak melebar, tak tampak batu / massa kistik / padat.

Ginjal Transplantasi :
Ukuran , 10,5 x 6,7 cm, korteks terlihat tebal, sistim pelviokalises dan ureter melebar, tak tampak
batu / massa kistik / padat.
Distribusi vaskular masih terlihat baik dan merata
RI a.interlobaris 0,69 (N : 0,561 - 0,675)
PSV a.renalis 62,9 cm/s

Kesan:
Chronic kidney disease bilateral.
Hidronefrosis dan hidroureter ginjal transplantasi dengan peningkatan nilai RI a.interlobaris, tidak
terlihat gangguan distribusi vaskular.

Pemeriksaan USG Doppler Ginjal Transplantasi :

Ukuran , 10,4 x 4,6 cm, korteks terlihat tebal, sistim pelviokalises dan ureter melebar, tak tampak
batu / massa kistik / padat.
Distribusi vaskular masih terlihat baik dan merata
RI a.interlobaris 0,58 (N : 0,528 - 0,618)
PSV a.renalis 80,7 cm/s

Kesimpulan : Distribusi vaskular ginjal transplantasi masih terlihat baik dan merata serta tidak terlihat
peningkatan nilai RI.

USG DOPPLER GINJAL:

Ginjal kanan:
Ukuran , 9,5 x 4,8 cm, tebal korteks maish baik, sistim pelviokalises dan ureter melebar, tak tampak
batu / massa kistik / padat.
Distribusi vaskular masih terlihat masih merata namun terlihat mengurang di daerah korteks.
RI a.interlobaris 0,72 (N : 0,603 - 0,733)
PSV a.renalis 102,4 cm/s

Ginjal kiri:
Ukuran , 9,0 x 5,2 cm, tebal korteks maish baik, sistim pelviokalises dan ureter melebar, tak tampak
batu / massa kistik / padat.
Distribusi vaskular masih terlihat masih merata namun terlihat mengurang di daerah korteks.
RI a.interlobaris 0,78 (N : 0,603 - 0,733)
PSV a.renalis 103,7 cm/s

Kesimpulan:

- Ukuran dan bentuk kedua ginjal masih baik, terlihat vaskuler yang mengurang di daerah korteks
kedua ginjal
- tampak peninggian nilai RI A interlobaris kiri
- Tak tampak peninggian nilai PSV A renalis .
HAMIL
Uterus membesar dengan GS didalamnya disertai janin tunggal , gerak (+), DJJ (+),
BPD 3,4 cm sesuai usia kehamilan 16 mgg
AC: 10,8 cm sesuai usia kehamilan 16 mgg'
FL :2,12 cm sesuai usia kehamilan 16 mgg
Tampaknya amnion sedikit.
Tampak bayangan hematom di sekitar uterus.

Kesan:
Hamil tunggal hidup, dengan usia kehamilan lebih kurang 16 mgg, amnion sedikit dengan hematom di
sekitar uterus dan terdapat asites ( hematoma ?)

KGB :
Reactive nodes (including those in tuberculous lymphadenitis) demonstrate prominent vascularity, but
mostly confined to the hilum, whereas malignant nodes demonstrate more peripheral / capsular
vascularity

Grey scale features :

Features that favour reactive / infective nodes over malignancy include:
 nodal matting
 surrounding soft tissue oedema

Doppler features :
Doppler examination is particularly useful in helping distinguish reactive nodes from metastatic disease
Reactive nodes (including those in tuberculous lymphadenitis) demonstrate:
 prominent hilar vascularity
Conversely features that favour malignancy include:
 peripheral / capsular vascularity
  avascular areas
 displacement of vessels
 aberrant course of hilar vessels

Nephroptosis, also known as a floating kidney and renal ptosis, is a condition in which the kidney
descends more than 2 vertebral bodies (or >5 cm) during a position change from supine to upright. The
condition is often treated with nephropexy, a surgical procedure that secures the floating kidney to the
retroperitoneum

CKD
 In patients with CKD, the renal cortical echogenicity increases at ultrasound
 renal cortex often becomes thinned
 Often this finding occurs with a normal bipolar renal length and an increase in the relative amount of
central sinus fat
 The renal cortical thickness was measured in the sagittal plane at the level of the mid kidney as
described by Moghazi et al.

Diabetic nephropathy
 Before reaching end-stage disease, imaging demonstrates enlarged kidneys or sometimes even
nephromegaly.
 Echogenicity increases with increasing renal insufficiency.
 When dialysis becomes necessary, the kidneys are still of normal size and little changed
 Scars, abscesses, and papillary necrosis can also occur in diabetics

Chronic pyelonephritis (more appropriately called chronic interstitial nephropathy)

 decreased renal function,
 reduced kidney size, and
 grossly scarred renal surface indentations that partly extend to the sinus and into the collecting
system.
 Echogenicity is inhomogenously increased,
 with the breadth of the parenchyma outlined or completely decreased.
Testis : ukuran x cm. Ekostruktur parenkim homogen. Tidak tampak lesi padat / kistik. Tidak
tampak kalsifikasi. Vaskular baik. Tidak tampak fluid collection di rongga scrotum.
Plexus pampiniformis : tidak tampak dilatasi vena-vena pada saat valsava manuver.

Pemeriksaan CT scan orbita tanpa kontras:

Bulbus okuli bilateral besar dan bentuk baik.

Nervus optikus kanan-kiri serta otot-otot bola mata bilateral kesan simetris dan tidak menebal.
Tidak tampak tampak gambaran massa intra/ekstrakonal.
Chiasma optikum baik, tidak tampak massa.
Dinding orbita dan basis kranii kesan intak
Sinus kavernosus kesan baik.
Rongga nasofaring simetris.
Tampak perselubungan di sinus maksilaris bilateral.
Deviasi septum nasi ke kanan dan terlihat konka bulosa konka nasalis media kiri.
Ostiomeatal kompleks masih terbuka.

Kesimpulan :
Tidak tampak kelainan pada orbita bilateral, tidak tampak massa intra/ekstrakonal.
Sinusitis maksilaris bilateral.
Deviasi septum nasi dan gambaran konka bulosa konka nasalis media kiri.
Lumbal:

Alignment baik, tidak tampak listesis ; kelengkungan berkurang tampak melurus

Struktur tulang baik. Tak tampak fraktur / destruksi pada corpus / pedikels.
Penyempitan posterior diskus L5-S1
Spur anterior lumbalis.
jaringan lunak baik

Kesan; Straight dan spondiloarthrosis lumbalis dengan penyempitan posterior diskus L5-S1 posterior.

Normal anatomy of parapharyngeal space. BS = buccal space, ICA = internal carotid artery, IJV =
internal jugular vein, MS = masticator space, PMS = pharyngeal mucosal space, PPS = parapharyngeal
space, PS = parotid space, PVS = prevertebral space, RPS = retropharyngeal space, SMS =
submandibular space, T = torus tubarius. Axial schematic at nasopharynx level shows that
parapharyngeal space is divided into prestyloid and poststyloid compartments by tensor-vascular-
styloid fascia connecting tensor veli palatini muscle with styloid process.

CT scan nasofaring dengan kontras iv.

Tampak massa di rongga nasofaring sisi kiri yang mengobliterasi torus tubarius dan fossa Rosenmuller
kiri, ke anterior massa mencapai bagian distal rongga kavum nasi sisi kiri, ke lateral mencapai spatium
parafaring kiri.
Masticator space baik.
Basis kranii intak, sinus kavernosus baik, tidak tampak infiltrasi massa ke intrakranial.
Tampak pembesaran kelenjar getah bening multipel colli bilateral, diameter terbesar kiri 3,48 cm dan
diameter terbesar kanan 3,4 cm.
Dinding sinus intak. Tampak penebalan mukosa sinus maksilaris bilateral, sinus paranasalis lainnya
bersih.

Kesan :
Massa nasofaring sisi kiri disertai limfadenopati multipel colli --> (T2b N2 Mx)
Tidak tampak infiltrasi massa ke intrakranial.
Sinusitis maksilaris bilateral.

Pemeriksaan CT scan nasofaring dengan kontras iv :

Rongga nasofaring kanan-kiri terlihat simetris, fossa Rosenmuller dan torus tubarius kanan-kiri tidak
tampak obliterasi.
Parafaring dan masticator space kanan-kiri baik.
Basis kranii intak, sinus kavernosus baik, tidak tampak infiltrasi massa ke intrakranial.
Tampak pembesaran kelenjar getah bening multipel colli bilateral, diameter kanan 0,4 - 1,4 cm dan
diameter kiri 0,8 - 1,2 cm.
Dinding sinus intak. Tampak penebalan mukosa sinus maksilaris kiri, sinus paranasalis lainnya bersih.

The measurement of aortic diameters, as follows: 1, aortic valve sinus; 2, ascending aorta at the level of
the right pulmonary artery; 3, proximal to the innominate artery; 4, proximal transverse aortic arch; 5,
distal transverse aortic arch; and 6, aortic isthmus.
Aortic diameters (mean ± SD) were
2.98 ± 0.46 cm aortic valve sinus,
3.09 ± 0.41 cm ascending aorta,
2.94 ± 0.42 cm proximal to the innominate artery,
2.77 ± 0.37 cm proximal transverse arch,
2.61 ± 0.41 cm distal transverse arch,
2.47 ± 0.40 cm isthmus,
2.43 ± 0.35 cm at the diaphragm.

http://jtcs.ctsnetjournals.org/cgi/content/full/123/6/1060

Pemeriksaan CT angiografi tungkai kanan-kiri dengan hasil sebagai berikut :

Aorta abdominalis distal, a. iliaca communis, a. iliaca externa dan interna, a. femoralis communis, a.
femoralis superfisialis dan profunda, a. poplitea, a. tibialis anterior - posterior, a. peroneus serta a.
dorsalis dan a. plantaris kanan-kiri beserta cabang-cabangnya kaliber dan bentuk baik, tidak tampak
stenosis, aneurisma maupun malformasi vaskular.

Kesimpulan :
Tidak tampak stenosis / aneurisma maupun malformasi vaskular di sistem arteri kedua tungkai.
Note :
lymphoma of the mesentery can appear as multiple round, mildly enhancing, homogeneous masses that
often surround mesenteric arteries and veins
Lymphoma of the mesentery can range in size (from small to bulky masses) and shape (from round or
oval soft-tissue opacities to irregular masses)
Mesenteric lymphomas grow to a large size and cause bulky adenopathy encasing mesenteric vessels
without producing clinical symptoms. On CT or ultrasound imaging, the confluent mesenteric nodes
resemble two halves of a sandwich and the tubular mesenteric vessels and perivascular fat resemble the
sandwich filling

Massa ukuran 9,9 x 9,6 x 11,1 cm (melingkupi usus halus, menyempitkan lumen, tidak tampak tanda
obstruksi di proksimalnya, fat mesenterika sekitar massa suram (infiltrasi?) serta menempel pada
dinding superior buli (tebal infiltrasi?)
kgb mesenterium diameter 2,6 - 6,8 cm.
HN kanan ec distensi buli?

KEsimpulan :
Massa multipel mesenterial kemungkinan suatu kgb (limfoma, desmoid?) dengan keterlibatan pada
usus halus dan a.v mesenterika.

Mega cisterna magna can be asymmetric and can manifest apparent mass effect, simulating the
appearance of an arachnoid cyst;

Most frequently (50 - 60%) arachnoid cysts are located in the middle cranial fossa, where they
invaginate into and widen the sylvian fissure. There is even a classification system for middle cranial
fossa arachnoid cysts, although I doubt it is of much use if a good description is provided (see Galassi
classification).
Mega cisterna magna Typically seen as prominent retrocerebellar cerebrospinal fluid (CSF) appearing
space with a normal vermis and normal cerebellar hemispheres

G Ital Nefrol. 2012 Sep-Oct;29(5):599-615.

[Ultrasound and color Doppler in nephrology.

Acute kidney injury].
[Article in Italian]
Meola M, Petrucci I.

Source
Scuola Superiore S. Anna Pisa, Pisa, Italy. mmeola@int.med.unipi.it

Abstract
At present, ultrasonography (US) is not able to define the type of renal damage and therefore cannot
replace percutaneous renal biopsy in the diagnosis of acute kidney disease. It is, however, the most
immediate and safest imaging technique for the evaluation of patients with acute kidney injury (AKI)
in order to exclude urinary tract obstruction or chronic kidney disease and guide clinical decision-
making. In prerenal AKI caused by cardiorenal syndrome type 1, US does not show specific signs.
However, in these patients, pleuropulmonary US is the first-choice imaging technique to evaluate the
congestion of subpleural interlobular septa and to identify and count lung comet tails. In cardiorenal
syndrome type 2, US visualizes signs of systemic overload (right pleural effusion, liver stasis,
overdistention and rigidity of the inferior vena cava and suprahepatic veins). In acute tubular necrosis
(ATN), the most common type of AKI, gray-scale US is nonspecific and shows enlarged kidneys with
hypoechoic pyramids due to medullary edema. The resistance index (RI) is a very useful marker to
establish the severity of ATN and the required follow-up, and to evaluate functional recovery, since its
reduction precedes the normalization of serum creatinine. US is the technique of choice in the diagnosis
of obstructive nephropathy, where it is highly sensitive (>95%) but less specific (<70%). The primary
objective of this review is to analyze the applications of US in the diagnosis of prerenal, renal and
postrenal AKI.
Radiol Med. 2001 Nov-Dec;102(5-6):340-7.

[Current role of color Doppler ultrasound in

acute renal failure].
[Article in Italian]
Bertolotto M, Quaia E, Rimondini A, Lubin E, Pozzi Mucelli R.

Source
UCO di Radiologia, Università di Trieste, Ospedale di Cattinara, Trieste, Italy. bertolot@univ.trieste.it

Abstract
Acute Renal Failure (ARF) is characterized by a rapid decline of the glomerular filtration rate, due to
hypotension (prerenal ARF), obstruction of the urinary tract (post-renal ARF) or renal parenchymal
disease (renal ARF). The differential diagnosis among different causes of ARF is based on anamnesis,
clinical symptoms and laboratory data. Usually ultrasound (US) is the only imaging examination
performed in these patients, because it is safe and readily available. In patients with ARF gray scale US
is usually performed to rule out obstruction since it is highly sensitive to recognize hydronephrosis.
Patients with renal ARF have no specific changes in renal morphology. The size of the kidneys is
usually normal or increased, with smooth margins. Detection of small kidneys suggests underlying
chronic renal pathology and worse prognosis. Echogenicity and parenchymal thickness are usually
normal, but in some cases there are hyperechogenic kidneys, increased parenchymal thickness and
increased cortico-medullary differentiation. Evaluation of renal vasculature with pulsed Doppler US is
useful in the differential diagnosis between prerenal ARF and acute tubular necrosis (ATN), and in the
diagnosis of renal obstruction. Latest generation US apparatus allow color Doppler and power Doppler
evaluation of renal vasculature up to the interlobular vessels. A significant, but non specific, reduction
in renal perfusion is usually appreciable in the patients with ARF. There are renal pathologic conditions
presenting with ARF in which color Doppler US provides more specific morphologic and functional
information. In particular, color Doppler US often provides direct or indirect signs which can lead to
the right diagnosis in old patients with chronic renal insufficiency complicated with ARF, in patients
with acute pyelonephritis, hepatic disease, vasculitis, thrombotic microangiopathies, and in patients
with acute thrombosis of the renal artery and vein. Contrast enhanced US is another useful diagnostic
tool in patients with ARF which has been recently introduced in clinical practice. Microbubble
administration may reduce technical failure in the evaluation of the renal artery. Moreover, perfusion
defects due to stenosis or thrombosis of the renal segmentary vessels are better recognized. New
diagnostic possibilities of enhanced US include evaluation of both cortical and medullar vessels, and
functional evaluation of renal perfusion. Measuring the transit time of the microbubbles is useful for
the diagnosis of renal artery stenosis and, in transplanted kidneys, for differential diagnosis between
ATN and acute rejection.
PMID:
11779981
[PubMed - indexed for MEDLINE]

Imaging (2008) 20, 1-19

  © 2008 British Institute of Radiology
doi: 10.1259/imaging/63493570

Renal impairment
1. C C Geddes, FRCP1 and
2. G M Baxter2
+ Author Affiliations
1. 1Consultant Nephrologist, Renal Unit, 2Consultant Radiologist, Department of Radiology,
Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK

Summary
1. Approximately 5% of the adult population has chronically reduced kidney function.
2. In the UK, guidelines have been implemented to identify patients with CKD by targeted
screening so that measures can be taken to reduce the increased cardiovascular risk and slow the
rate of deterioration in kidney function.
3. There is a direct relationship between renal length and parenchymal thickness; both are
generally reduced in renal impairment. Ultrasonic renal length is normally 10–12 cm; less than
9 cm is generally pathological. Increased renal cortical echogenicity on ultrasound is a good
indicator of renal parenchymal disease.
4. The principal types of acute kidney injury (AKI) are pre-renal, parenchymal or post-renal; a
pre-renal aetiology is the most common. Ultrasound should usually be performed early to
exclude obstruction. If a parenchymal aetiology of AKI is suspected, then kidney biopsy is
required.
5. In patients with CKD, renal artery stenosis (RAS) should be suspected in those with
hypertension and stigmata of widespread atheromatous disease. Magnetic resonance
angiography (MRA) and CT angiography are usually useful in patients suspected of having
RAS.
Renal impairment represents a huge healthcare issue not just within the UK but also worldwide. Both
the incidence of acute kidney injury and, with the ageing population, chronic kidney disease are
increasing. This article will review the normal anatomy (in particular, the normal ultrasonic anatomy)
of the kidney and highlight the main physiological roles of the kidney in order to enable a better
understanding of how, once these functions fail, the clinical consequences arise. We will address the
investigation and management of patients with both acute and chronic disease, as well as the aetiology,
investigation and imaging options available. The classification of chronic kidney disease and its
relationship with the estimated glomerular filtration rate will be discussed. The pivotal role of
ultrasound in the imaging armamentarium will be highlighted. Finally, the risks of contrast-induced
nephropathy, as well as the recommendations for MRI use to reduce any risk of nephrogenic systemic
fibrosis, will be discussed.

Pemeriksaan CT angiografi cerebral hasil sebagai berikut :

A.carotis interna, carotis siphon kanan-kiri beserta cabang-cabangnya kaliber dan bentuk baik, tidak
tampak stenosis, aneurisma, maupun malformasi vaskular.
A. cerebri anterior, cerebri media kanan-kiri beserta cabang-cabangnya kaliber dan bentuk baik, tidak
tampak stenosis, aneurisma, maupun malformasi vaskular.
A. vertebralis kanan-kiri, basilaris, a.cerebri posterior kanan-kiri beserta cabang-cabangnya kaliber dan
bentuk baik, tidak tampak stenosis, aneurisma, maupun malformasi vaskular.

Kesimpulan :
Tidak tampak tanda stenosis, aneurisma maupun malformasi vaskular pada CTA cerebral saat ini.
DERAJAT STENOSIS CT CARDIAC

http://emedicine.medscape.com/article/1603072-overview#aw2aab6c12

Cross-sectional images at the level of the most severe narrowing can be compared to a reference
minimal lumen diameter averaging the segments proximal and distal to the stenosis. The diameter
should be measured lumen to lumen rather than wall to wall. The distal reference vessel should not be
distal to a bifurcation.
Because the spatial resolution is inadequate for precise grading, coronary stenoses are often graded
with semiquantitative descriptors such as
1. normal,
2. mild (< 50%),
3. moderate (50–70% stenosis),
4. severe (>70% stenosis),
5. occluded.
Stenosis is typically overestimated in areas where heavily calcified plaques are present. In the presence
of extensive calcification, reconstruction of a additional dataset using a sharper convolution kernel (as
used for stents) and use of bone window setting can reduce blooming artifacts from calcification.[76]
Zhang et al offer the following suggestions to better assess the degree of stenosis when calcified
plaques are present[77] :
 A significant luminal stenosis is unlikely if the plaque thickness measures 50% or less of the
diameter of a nearby normal segment and if it is eccentrically positioned on a cross-sectional
multiplanar reconstruction (MPR) view or there is visible lumen adjacent to the plaque on a
long-axis MPR view, .
 A significant stenosis is likely if calcified plaque fills the entire central portion of the lumen on
a cross-sectional MPR image.
 A significant stenosis can be suggested if calcified plaque is 50% or greater than the diameter of
a nearby normal segment on cross-sectional MPR images but does not completely fill the
lumen; however, the interpreter might add that CCTA may overestimate the degree of stenosis
in this situation.
Pitfalls
Several areas may be difficult to evaluate due to curvature, and additional review of these regions using
thick-slap MIP may be helpful, as follows:
 Distal segment of the RCA and origin of the PDA
 Origin of the first diagonal branch
 Distal circumflex near the origin of the obtuse marginal
A stenosis should always have an associated visible plaque, calcified or noncalcified. This is helpful in
differentiating stenosis from artifactual apparent narrowing.
ABDOMINAL US:

Liver: was normal in size and contour, no any focal lesion seen. Intrahepatic biliary duct was also
normal as well.
The gallbladder normal in size without evidence of bile stone.
The pancreatic gland and spleen was normal in size and contour.
Both kidneys show normal contour and size, no stone nor cyst was discerned.
The urinary bladder was normal in size and contour and the prostatic gland was normal as well.
No ascitic fluid and no regional lymph nodes enlargement seen.

Uterus was normal in size and contour, no intramural mioma seen. No solid nor cystic mass in both
adnexas.

Impression : Normal abdominal ultrasound

Brain CT :

Brain cortical sulci and gyri are normal.

White and gray matter differentiation are normal.
Ventricle system and cystern are not enlarged.
No abnormalities at the basal ganglia, thalamus and corpus callosum structure.
No hypo/hyperdense lesion at the bilateral cerebral and cerebellar hemisphere.
No abnormalities at the pons, CPA region and cerebellum.
Calvarial bone are intact.

Conclusion : There is no abnormalities at the brain CT scan.

Chest radiograph :

Heart is not enlarged.

Aorta and medistinum structure is not widening.
Trachea and hilar are normal.
No sign of lung infiltrate / nodules
Sinuses and diaphragm are normal.

Conclusion : Normal chest x-ray

Varicocele is basically a clinical diagnosis and the most often used classification (with
modifications by some) is Dubin and Amelar classification.

Mild - Varicoceles palpable only on valsalva.

Moderate- Varicoceles palpable without valsalva.
Severe - Varicoceles visible through skin.

It was a good enough classification till studies were published which showed subclinical varicoceles
impairing fertility/ sperm quality and treatment of subclinical (i.e. non palpable) varicoceles associated
with improvement. Furthermore clinical examination was not accurate enough, and not possible in a
few subsets of patients (obese/ previous surgery etc). Hence the use of doppler ultrasound.

There is no standard definition of varicocele on ultrasound, let alone of grading it. Venous diameter of
> 3mm is generally considered reasonable for diagnosis of varicocele. Plus there may/ may not be
reflux and if present it may not be sustained (depends on the cause of varicocele - due to shunt or due
to reflux).
One classification I follow (given in Dahnert, don't know the source):

Grade............relaxed state............Valsalva
Normal.............2.2 mm.................2.7mm
Small V...........2.5-4.0 mm.............increase by 1mm
Moderate V......4.0 - 5.0 mm...........increase by 1.2-1.5 mm
Large V...........>5.0 mm................increase by > 1.5mm

This review article echoes the problem of diagnosing varicoceles.

www.andrologyjournal.org/cgi/content/full/29/2/143

CT Angiografi Aorto-Iliaka:

Kaliber dan kontur Aorta bagian distal baik, densitas vaskuler juga baik, tak tampak adanya filling
defect / plaque thrombus, tak tampak adanya aneurisma.
TAmpak kaliber dan kontur A Iliaka komunis, Iliaka interna dan eksterna baik dan reguler, densitas
vaskuler baik, tak tampak adanya filling defect / plaque thrombus, tak tampak adanya aneurisma.

Kesimpulan:
- Tak tampak kelainan pada CT Angiografi Aorto-Iliaka.

Pemeriksaan CT angiografi renalis :

Ginjal kanan mendapat perdarahan dari 1 a. renalis kanan yang bercabang menjadi a. superior
segmental, middle segmental, dan inferior segmental.
Ginjal kiri mendapatkan perdarahan dari a. renalis kiri yang bercabang menjadi a. superior segmental,
middle segmental, dan inferior segmental. Terlihat segmen inferior mendapatkan perdarahan dari
arteri renalis asesoris merupakan cabang langsung dari aorta abdominalis.

Kesimpulan :
Ginjal kanan mendapatkan vaskularisasi dari 1 a. renalis
Ginjal kiri mendapatkan vaskularisasi dari 1 a.renalis utama dan a.renalis asesoris.

Pemeriksaan CT angiografi renalis :

Ginjal kanan mendapat perdarahan dari 1 a. renalis kanan yang bercabang menjadi a. superior
segmental, middle segmental, dan inferior segmental. Terlihat segmen superior juga mendapatkan
perdarahan dari percabangan segmen proksimal a. renalis kanan.
Ginjal kiri mendapatkan perdarahan dari a. renalis kiri yang bercabang menjadi a. superior segmental,
middle segmental, dan inferior segmental. Terlihat segmen superior mendapatkan perdarahan dari
arteri renalis asesoris merupakan cabang langsung dari aorta abdominalis.

Kesimpulan :
- Ginjal kanan mendapatkan vaskularisasi dari 1 a. renalis
- Ginjal kiri mendapatkan vaskularisasi dari 1 a.renalis utama dan a.renalis asesoris.
CTA BRAIN
Clinical History

* Medical history
* Risk factors
* Allergies, if relevant
* Reason for exam, including medical necessity: [headache | stroke | dizziness | trauma | aneurysm
history]

Imaging Technique

* Time of image acquisition

* Imaging device [MR]
* Image acquisition parameters, such as device settings, patient positioning, interventions (e.g.,
Valsalva maneuver):
* [3D time-of-flight; 2D time-of flight; 2D phase contrast; 3D phase contrast; MOTSA; dynamic
enhanced]
* Contrast materials and other medications administered (including name, dose, route, and time of
administration)

Comparison

* Date and type of previous exams reviewed, if applicable

Observations

* Image Quality

o Image quality; [normal flow related enhancement*]

* Anatomy

* Distal internal carotid artery {left/right}: [normal* ; narrowed; dissected; irregular; aneurysmal;
occluded]
* Petrous carotid artery {left/right}: [normal* ; narrowed; dissected; irregular; aneurysmal;
occluded]
* Cavernous carotid artery {left/right}: [normal* ; narrowed; dissected; irregular; aneurysmal;
occluded]
* Supraclinoid internal carotid artery {left/right}: [normal* ; narrowed; dissected; irregular;
aneurysmal; occluded]
* Communicating segment internal carotid artery {left/right}: [normal* ; narrowed; dissected;
irregular; aneurysmal; occluded]
* Anterior cerebral artery complex (MCA): [normal* ; narrowed; dissected; irregular; aneurysmal;
occluded]
* Middle cerebral artery complex (MCA) {left/right}: [normal* ; narrowed; dissected; irregular;
aneurysmal; occluded]
* Vertebral artery (VA) {left/right V3 & V4 segments}: [normal* ; narrowed; dissected; irregular;
aneurysmal; occluded]
* Posterior inferior cerebellar artery (PICA) {left/right}: [normal*; absent; narrowed; dissected;
irregular; aneurysmal; occluded]
* Basilar artery (BA): [normal* ; narrowed; dissected; irregular; aneurysmal; occluded; fenestrated]
* Anterior inferior cerebellar artery (AICA) {left/right}: [normal*; absent; narrowed; dissected;
irregular; aneurysmal; occluded]
* Superior cerebellar artery (SCA) {left/right}: [normal*; absent; narrowed; dissected; irregular;
aneurysmal; occluded]
* Posterior cerebral artery (PCA) {left/right}: [normal*; absent; narrowed; dissected; irregular;
aneurysmal; occluded]

* Pathology

* Aneurysm: [none*]
o size {broadest diameter x perpendicular}: [<#>mm x <#>mm]
o type: [berry | atherosclerotic | fusiform | mycotic]
o artery of origin: [text]
o neck dimension {if applicable}: [<#> mm]
o dome direction projected: [superior; inferior; anterior; medial; lateral]
o thrombosis: [none* |partial |complete]
* Vascular malformation: [none*]
o type: [pial | dural | mixed]
o nidus size {largest diameter x perpendicular x perpendicular}: [<#>mm x <#>mm x <#>mm]
o arterial feeders {internal/external branches}: [internal | external | mixed]
o associated aneurysms {arterial/venous varices}; [text]

* Misc

* Developmental variants: [fetal origin posterior cerebral artery {left/right}; AICA/PICA {left/right};
PICA/AICA {left/right}; AICA/AICA {left/right}; persistent trigeminal artery]

Summary (or Impression)

 An itemized list of key observations, including any recommendations.

PERDARAHAN MRI

The breasts are extremely dense (greater than 75% fibroglandular), which could obscure a lesion on
mammography. There are multiple well-circumscribed masses bilaterally that correlate to the palpable
areas, which are demarcated by metallic markers. No suspicious calcifications are seen.
Targeted ultrasound of bilateral breasts was performed in the region of palpable abnormalities and
demonstrates multiple simple cysts.
Differential diagnosis
 Simple cyst
 Complicated or complex cyst
 Galactocele
 Hematoma
 Fat necrosis or oil cyst
 Abscess
 Intracystic papilloma
 Necrotizing neoplasm
Diagnosis: Simple cysts
Discussion
Breast cysts are the most common masses seen with mammography. Cysts can present at any age
but are most common in women ages 30 to 50. They can be asymptomatic or present as a palpable
lump (cysts are the most common cause of palpable breast lumps in women between ages 35 and 50).
Cysts occur because of fluid accumulation in the terminal ductal lobular unit.
On mammography, cysts present as circumscribed round or oval masses that wax and wane. For
simple cysts to be definitively characterized on ultrasound, they must meet all criteria described by
Stavros: anechoic, well-circumscribed with an imperceptible wall, and have increased through-
transmission. Simple cysts characterized on ultrasound can be classified as a BI-RADS 2 (benign), and
patients can resume routine annual mammography. Multiple fluctuating masses of varying sizes on
mammography likely reflect cysts; an ultrasound may not be necessary in all cases. On MRI, simple
cysts are circumscribed, nonenhancing, and hyperintense on T2. The differential diagnosis for simple
cysts includes hematoma, galactocele, and oil cyst.
Cysts with low-level internal echoes or debris are characterized as complex cysts. The differential
diagnosis for complex cysts includes hematoma, galactocele, and oil cysts. Complicated cysts will be
hyperintense on T1 due to internal hemorrhage, protein, or fat. Complicated cysts can usually be
classified as a BI-RADS 3 (probably benign) with only a 0.2% of malignancy; complicated cysts can
be aspirated or short-interval follow-up can be obtained in six months.
Complex cysts, on the other hand, have thickened walls/septa or mural nodularity. The differential
diagnosis of complex cysts include abscess, intracystic papilloma, papillary carcinoma, hematoma, fat
necrosis, galactocele, and necrotic neoplasm. The presence of a solid component or mural nodule raises
the suspicion of a cystic neoplasm; lesions should be characterized as a BI-RADS 4, and biopsy should
be performed.
Cysts can be aspirated under ultrasound if they are symptomatic. The aspirate can be discarded unless
the fluid is bloody, in which case it is sent for cytology as the cyst may be related to a neoplasm that
has bled.

Classification of congenital anomalies of the uterus:

 Class I: Agenesis of the uterus and/or cervix
  Class II: Unicornuate uterus (half of the uterus develops)
 Class III: Didelphys uterus (complete non fusion of the Müllerian ducts)
 Class IV: Bicornate uterus (partial nonfusion of the müllerian ducts)
 Class V: Septate uterus (failure of the septum between with two uterine horns to absorb)
Didelphys uterus
 A didelphys uterus results from complete nonfusion of the müllerian ducts.
 The individual horns are completely or nearly completely developed and are normal in size.
 Two cervices are invariably present.
 A longitudinal or transverse vaginal septum may be present as well. Didelphys uterus has the
highest association with a septum, but this can be seen in other anomalies as well.
 Pregnancies have been carried to term with this type of uterus.

Differential diagnosis - intraventricular mass

 Primary tumors:
 Ependymomas: Fourth ventricle
 Central neurocytoma: Lateral ventricle
 Subependymoma: Frontal horn or fourth ventricle
 Intraventricular meningiomas: Left atrium
 Choroid plexus papilloma
 Child: Left atrium
 Adult: Fourth ventricle
 Metatastasis: Most common are renal and lung carcinoma.
 Lymphoma
 Infection: Tuberculoma and neurocysticercosis
MRI Confluent white-matter changes (broad, limited differential is provided below)
 Chronic small-vessel disease: Seen in older patients (usually older than age 60).
 Progressive multifocal leukoencephalopathy: Immunocompromised patients.
 HIV encephalitis: Will have white-matter changes, but will also have diffuse cerebral atrophy.
 Demyelinating disease: Clinical history and cerebral spinal fluid sampling (oligoclonal bands in
multiple sclerosis).
 Radiation therapy: Clinical history needed.

CT cardiac
Many experienced cardiologists are able to visually determine the severity of stenosis and semi-
quantitatively measure the vessel diameter. However, for greatest accuracy, digital cath labs have the
capability of making these measurements and calculations with computer processing of a still image.
The computer can provide a measurement of the vessel diameter, the minimal luminal diameter at the
lesion site and the severity of the stenosis as a percentage of the normal vessel. It uses the catheter as a
reference for size. Note that cardiac catheters come in various outer diameters that are referred to as
"French" units. One French = 0.33 or 1/3rd mm. Thus, a 6F (French) catheter has an outer diameter
(OD) of 1/3 x 6 = 2 mm, while a 9F catheter has an OD of 1/3 x 9 = 3 mm. A table of various French
sizes are shown below:
 1 French = 0.33 or 1/3 mm
 3 French = 1 mm
 6 French = 2 mm
 7 French = 2 1/3 or 2.33 mm
 8 French = 2 2/3 or 2.66 mm
 9 French = 3 mm
 10 French = 3 1/3 or 3.3

Descriptive Lumen Obstruction Quantitative Stenosis Grading

Normal Absence of plaque/no luminal stenosis
Minimal Plaque with <25% stenosis
Mild 25%–49% stenosis
Moderate 50%–69% stenosis
Severe 70%–99% stenosis

Descriptive Lumen Obstruction Qualitative Stenosis Grading

Normal Absence of plaque/no luminal stenosis
Minimal Plaque with negligible impact on lumen
Mild Plaque with no flow-limiting stenosis
Moderate Plaque with possible flow-limiting disease
Severe Plaque with probable flow-limiting disease
Occluded

CT CARDIAC Quantitative Stenosis Assessment

Three cross-sectional computed tomography (CT) images of the proximal left anterior descending
coronary artery (LAD) are shown demonstrating cross-sectional measurements of percentage diameter
stenosis, calculated by comparing minimal luminal diameter at the site of maximal stenosis with
normal reference diameters proximal and/or distal.
(A) shows the LAD lumen proximal to stenosis.
(B) shows the LAD lumen at the site of minimum lumen diameter.
(C) shows the LAD lumen distal to the stenosis.
Percentage diameter stenosis = (3.3 mm − 2.2 mm)/3.3 mm = 33%. It must be noted that window-level
settings may influence the displayed luminal diameter measurements.

On the left an overview of the coronary arteries in the anterior projection.

 Left Main or left coronary artery (LCA)
 Left anterior descending (LAD)
 diagonal branches (D1, D2)
 septal branches
 Circumflex (Cx)
  Marginal branches (M1,M2)
 Right coronary artery
 Acute marginal branch (AM)
 AV node branch
 Posterior descending artery (PDA)

On the left an overview of the coronary arteries in the right anterior oblique projection.
 Left Main or left coronary artery (LCA)
 Left anterior descending (LAD)
 diagonal branches (D1, D2)
 septal branches
 Circumflex (Cx)
 Marginal branches (M1,M2)
 Right coronary artery
 Acute marginal branch (AM)
 AV node branch
 Posterior descending artery (PDA)
On the left an overview of the coronary arteries in the lateral projection.
 Left Main or left coronary artery (LCA)
 Left anterior descending (LAD)
 diagonal branches (D1, D2)
 septal branches
 Circumflex (Cx)
 Marginal branches (M1,M2)
 Right coronary artery
 Acute marginal branch (AM)
 AV node branch
 Posterior descending artery (PDA)
64 MSCT coronary artery: dibuat tanpa dan dengan kontras Iodine injeksi.

Syngo Calcium Scoring :

LM : 0
LAD : 3,8
LCX : 0
RCA : 0
Toral calcium score: 3,5 units

CTCA (CT Coronary Angiogram) :

LM : normal, bifurcatio LAD-LCX baik.
LAD : tampak plaque kalsifikasi pada proksimal, tidak tampak stenosis.
Diagonal 1 : normal.
Diagonal 2 : tampak soft plaque dengan 77-80 % stenosis.
LCx : normal.
M1 : normal.
RCA : normal.
AM : normal

Kesimpulan:
- Soft plaque pada Diagonal 2 LAD kemungkinan menyebabkan severe stenosis
- Calcified plague proksimal LAD tanpa stenosis

Usul : DSA Angiografi coronaria.

. The size of the normal pancreas was found to be up to 3.0 cm for the head, 2.5 cm for the neck and
body, and 2.0 cm for the tail.
EMFISEMA.
CBD diameters in patients more than 50 years of age can be more than 7 mm and be within normal
limits.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852735/
USG doppler arteri tungkai bilateral :

Terlihat calcified plaque di distal a. tibialis anterior kanan (ukuran +/- 3,4 x 2,5 mm) yang tampaknya
menyebabkan stenooklusi total sehingga tidak terlihat flow vaskular pada segmen distalnya dan a.
dorsalis pedis kanan, masih terlihat flow vaskular di proksimal a. tibialis anterior kanan (PSV 22,5
cm/s)

Nilai PSV pada :

- a. femoralis communis kanan (72,9 cm/s) dan kiri (80,3 cm/s)
- a. femoralis profunda kanan (72,0 cm/s) dan kiri (93,6 cm/s)
- a. femoralis superfisialis kanan (72,9 cm/s) dan kiri (67,7 cm/s)
- a. poplitea kanan (63,0 cm/s) dan kiri (56,8 cm/s)
- a. tibialis posterior kanan (37,4 cm/s) dan kiri (34,1 cm/s)
- a. tibialis anterior kiri (30,6 cm/s) dan dorsalis pedis kiri (31,2 cm/s).
Tampak kalsifikasi multipel pada dinding arteri tungkai bilateral lainnya namun tak tampak nyata
stenosis dengan spektrum doppler pada arteri yang tervisualisasi terlihat masih trifasik dan tidak
terlihat peningkatan PSV

Kesimpulan :
Gambaran PAD tungkai bilateral disertai kemungkinan stenooklusi total pada segmen a. tibialis anterior
kanan bagian distal.

Usul : Arteriografi tungkai bilateral.

Coronary artery bypass graft
http://radiopaedia.org/articles/coronary-artery-bypass-graft

Dr Yuranga Weerakkody and Dr Praveen Jha et al.

A coronary artery bypass graft (CABG) is placed during a surgical procedure to increase blood flow
to the myocardium due to coronary stenoses, usually caused by coronary artery disease. Arteries or
veins can be grafted during this procedure.
Long term outcome of coronary artery bypass grafting depends on graft patency. Angiography was
done for routine assessment of CABG, especially when the patient presented with recurrent angina.
However, in the era of cardiac multidetector CT imaging, screening of grafts for patency is quite useful
in early (< 1 month) as well as late (> 1 month) post-operative period. Thus, it is important to know the
appearances of various bypass grafts.

Types of coronary artery bypass grafts

Saphenous vein grafts

Saphenous grafts are the earliest grafts used for CABG, which are still most widely used in coronary
bypass surgeries. Saphenous vein conduits are harvested from legs, and grafted from ascending aorta
(usually anterior aspect) to distal coronary artery beyond the obstructive lesion. Right coronary grafts
are usually anastamosed to right coronary artery or posterior descending artery. Left coronary grafts are
usually anastomosed to left anterior descending (LAD), left circumflex, obtuse marginal or diagonal
branches. Saphenous grafts are most convenient, however most prone to occlusion. In CT imaging, it
may not be possible to see the distal anastamosis, however, continous contrast column in graft, can be
taken as patent graft. Most grafts are directly sutures to aorta, however, recently aortovenous connector
devices have also come, which appear differently in imaging.

Internal thoracic artery grafts

Left internal thoracic (or mammary) artery (ITA) grafts have emerged as preferred bypass graft due to
its excellent graft patency and close proximity to LAD. It is seen on imaging, as proximal end from
normal anatomical origin (left subclavian artery), and distal end usually anastamosed to LAD. Right
internal thoracic artery graft can also be used in similar fashion.
In two-vessel disease, LITA is connected to the LAD, and RITA is attached proximally to LITA and
distally to the second target vessel. In this case, both arterial grafts have better patency rates than
venous grafts.

Other arterial grafts

 radial artery - used after harvesting from forearm
 gastroepiploic artery - used by extended sternotomy and is dissected from the greater curvature
of stomach and anastamosed to the target vessel (difficult and rare surgery)

Complications of coronary artery bypass grafts

 thrombosis: most common in early post-operative period, due to improper anti-coagulation or
 endothelial damage during surgery
 graft malposition or kinking
 graft kinking can cause graft occlusion.
 it is especially common in longer grafts and graft with connector devices
 graft spasm
 this is common in radial artery grafts
 it is seen in early post-operative period. In case of graft spasm, proximal graft appears
narrower than distal graft (c.f. graft stenosis, where distal graft is narrower)
 iatrogenic complications
 graft damage during surgery
 retained clips
 graft aneursyms
 aneurysmal dilatation of graft >2 cm is considered significant, and will require surgery.
 pseudoaneurysms may arise at the proximal or distal ends of grafts

Non-graft related surgical complications

 pleural or pericardial effusion
 sternal, mediastinal or donor-site infection
 pulmonary embolism
http://www.ajronline.org/doi/full/10.2214/AJR.08.2166

TABLE 1: Maximal Normal Aortic Diameter

Segment Size (cm)

Ascending 4
Descending thoracic 3
Abdominal 2

TABLE 2: Aortic Aneurysm Size Criteria a

Segment Size (cm)

Ascending 5
Descending thoracic 4
Abdominal 3

aEqualing or exceeding 1.5 times the expected normal diameter.

Pemeriksaan CT scan angiografi aorta :

Kaliber dan bentuk aorta thoraco-abdominalis terlihat baik, tidak tampak diseksi, aneurisma maupun
malformasi vaskular. Terlihat calcified plaque multipel pada segmen aorta abdominalis.
Diameter aorta sbb :
- Aortic sinuses of valsava (D1) : cm.
- Sinotubular junction (D2) : cm.
- Mid ascending aorta (D3) : cm.
- Proximal arcus aorta (D4) : cm.
- Mid arcus aorta (D5) : cm.
- Proximal descending thoracic aorta (D6) : cm.
- Mid descending aorta (D7) : cm.
- Aorta level diafragma (D8) : cm.
- Aorta abdominalis level trunkus coeliacus (D9) : cm.
- Aorta abdominalis level cephalic arteri renalis (D10) : cm.
- Aorta abdominalis level caudal arteri renalis (D11) : cm.
- Aorta abdominalis infrarenal (D12) : cm.
- Aorta abdominalis diatas bifurcatio (D13) : cm.

Kesimpulan :
- Tidak tampak gambaran aneurisma / diseksi aorta.
Left lung
The left lung is subdivided into two lobes and thereby, into eight segments:
 left upper lobe
 apicoposterior segment
 anterior segment
 superior lingular
 inferior lingular
 left lower lobe
 superior segment
 anteromedial segment
 lateral segment
 posterior segment

Right lung
The right lung is subdivided into three lobes with ten segments:
 right upper lobe
 apical segment
 posterior segment
 anterior segment
 right middle lobe
 lateral segment
 medial segment
 right lower lobe
 superior segment
 anterior segment
 medial segment
 lateal segment
 posterior segment
USG DOPPLER ARTERI TUNGKAI KANAN:

Kutis dan subkutis baik.

arteri femoralis, femoralis superfisialis, poplitea, tibialis posterior dan peroneus,
kaliber dan konturnya baik, tampak adanya lesi intraluminer didalamnya , spektrum doppler
monofasik sampai A femoralis superfisialis, selanjutnya ke distal terlihat pelebaran spektrum dengan
peak rendah
tampak obstruksi di daerah poplitea dan peroneus

Kesimpulan:
Tampak tanda PAD tungkai kanan dengan kemungkinan obstruksi A poplitea dan peroneus

Usul: CT Angiografi tungkai kanan