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
POLA NORMAL UDARA DALAM
SALURAN PENCERNAAN

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
 NORMAL FLUID LEVEL

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 VS USUS KECIL
Usus Besar
Perifer
Haustra: plika semi lunaris
Diameter < 6 cm, cecum <9 cm

Usus Kecil
Central
Valvulae: plika sirkularis
Diameternya < 3 cm
 PROYEKSI FPA
 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
 FPA SUPINE
Untuk melihat :
• Pola udara dalam usus
• Kalsifikasi
• Soft tissue mass
• Tulang
 FPA PRONE
Untuk melihat :
• Udara dalam rectum/
sigmoid
• Udara dalam colon asenden
dan desenden
 FPA ERECT
Untuk melihat :
• Free-air

• Air fluid level

Dapat digantikan
dengan Proyeksi Left
Lateral Decubitus(LLD)
PNEUMOPERITONEUM
 PNEUMOPERITONEUM
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 )
 PNEUMOPERITONEUM

Gambaran Radiologi :
 Cupula sign
 Foot ball sign
 Double wall sign /Rigler sign
 Ligamentum falciforum sign
 Umbilical sign
 Urachus sign
 PROYEKSI FOTO
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

Free Intraperitoneal Air

ABNORMALITAS POLA
UDARA DALAM USUS
 ABNORMALITAS POLA UDARA

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 loop Distended

SBO - Multiple dilated loop -

LBO - None-unless Ileocecal Dilated

valve incompetent
LOCALIZED ILEUS ( Sentinel Loop )

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
 GENERALIZED ILEUS

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

SMALL BOWEL OBSTRUCTIONS

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
LARGE BOWEL OBSTRUCTIONS
 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 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.
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.
BARIUM SWALLOW AIR CONTRAST

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

ABNORMAL MOTILITY
 AKALASIA

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
AKALASIA
VARISES ESOFAGUS
ESOFAGITIS PEPTIK
KARCINOMA ESOFAGUS
DIVERTIKEL ESOFAGUS
ESOFAGUS BARRETT
BARIUM FOLLOW THROUGH
 BARIUM ENEMA
COLON IN LOOP

- Single contrast
- Double contrast
 CA COLON

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

VIRTUAL CT-COLONOGRAPHY
ORGAN VISERA
 ORGANS

• Liver
• Gallbladder
• Pancreas
• Spleen
• Stomach
• Small intestine
• Large Intestine
Organ  plain radiograph  hard to see
 AXIAL IMAGING

• CT
• MRI
• ULTRASOUND
COMPUTED TOMOGRAPHY

Contras ?
• Oral
- Dilute iodine
- Dilute barium

• Intravenous
- Iodine ( Non-ionic )
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