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Emergency inRadiology (Abdomen
Renata Nurul setyawati 20090310094
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PendahuluanPemeriksaan radiografi polos dalam kasus kedaruratan di negara maju perannyasudah semakin sempit dan diganti dengan teknologi CT scan serta perangkatdigital lainnya termasuk USG dan MRI meskipun demikian, alat tersebut masihtetap dipakai karena murah, mudah dan cepat untuk kasus tertentu
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Penilaian pada foto polos abdomen
Preperitoneal fat line
Psoas line
Pola udara dalam saluran cerna
Adanya udara bebas
Soft tissue mass(+)/(-)
Kalsifikasi (+) / (-)
Tulang
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FOTO POLOS ABDOMEN
A Normal plain film of the abdomen. The lower margins of the posteriorportion of the liver, the hepatic angle (H), and the lower part of thespleen (S) are delineated by a fat shadow. Both kidneys (K) and thepsoas muscle shadows (arrowheads ) are outlined by a fat shadow. Theproperitoneal fat stripe is also shown bilaterally (arrows ). B Diagram ofnormal abdominal plain film.
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Pola normal udara dalam saluranpencernaan
Lambung : Udara selalu (+)
Usus kecil : terlihat 2-3 loop usus, tak adadistensi.Diameter < 3cm
Rectum dan Sigmoid : selalu terlihat
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Udara dalam
lambung
Udara terlihat pada
bbrpa loop usus
halus
Udara dalam Rec
& Sigmoid
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Normal fluid level
Lambung : selalu (+), kecuali proyeksisupine
Usus kecil: 2-3 fluid level masih normal
Usus besar : 2-5 fluid level masih normal
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Air fluid leve
lambung
Air fluid level
sedikit pada usus
kecil
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PNEUMOPERITONEUM
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PneumoperitoneumPneumoperitoneum merupakan keadaan adanya udara bebas
dalam rongga peritoneum. Hal ini bisa disebabkan perforasi orgberongga abdomen akibat trauma tumpul abdomen.
Etiologi :
Ruptur viskus berongga (yaitu perforasi ulkus peptikum,necrotizing enterocolitis, megakolon toksik, penyakit ususinflamasi)
Faktor iatrogenik (yaitu pembedahan perut terakhir, traumaabdomen, perforasi endoskopi, dialisis peritoneal, paracentes
Infeksi rongga peritoneum dengan organisme membentuk gasdan atau pecahnya abses yang berdekatan
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Signs of pneumoperitoneum of supine radiogr
Right upper quadrant gas
Peri hepatic
Sub hepatic
Morrisons pouch
Fissure for ligament teres
Riglers (double wall sign)
Ligament visualization
FalciformUmbilical inverted V sign
Triangular air
The cupola sign
Football or air dome
Gas in subhepatic space
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Gas in subhepatic space
Supine abdominal radiograph shows an elliptical collection of air within th
subhepatic space
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Doges cap sign
Doges Cap sign refers to free air inMorrison's pouch.
Morrison's pouch is normally apotential space between the rightkidney and the liver
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Triangular gas shadow superior to kidney and postero-inferior to 11thrib
Ri l i
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Riglers sign
Rigler's sign refers to the appearance of the bowel wall o
plain film when it is outlined by intraluminal and extralumi
air .The extra luminal air is free peritoneal gas
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Falciform ligament visualization
Visualization of Falciform ligament by free gas on either sid
the ligament
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Football sign
The football sign likens the massively air-filled peritoneum to an
American football
In the supine position, free air collects anterior to the abdominalviscera, producing a sharp interface with the parietal peritoneum andthereby creating the football outline
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Double Bubble Sign
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Double Bubble Sign
Two collections of overlapping gas- one of these collections is sub diaphragmatic
gas and the other is normal gas within the fundus of the stomach
The Cupola Sign
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The Cupola Sign
An arcuate collection of free intraperitoneal air beneath the central tendon
diaphragm. The superior border is well defined (arrows) compared with the in
extent of the collection.
The Triangle Sign
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The Triangle Sign
The triangle sign refers to small triangles of free gas that can typically be position
between the large bowel and the flank(black arrow)
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Semilunar Shadow
Gambaran udara (radiolusen) berupa daerah berbentuk bulan sabit (Semiluna
Shadow) diantara diafragma kanan dan hepar atau diafragma kiri dan lien
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ILEUS
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ILEUS OBSTRUKTIF
Ileus obstruktif merupakan penyumbatan intestinal mekanik yang terjadi karena
adanya daya mekanik yang bekerja atau mempengaruhi dinding usus sehinggamenyebabkan penyempitan atau penyumbatan lumen usus.
Klasifikasi
Berdasarkan lokasi obstruksinya, ileus obstruktif dibedakan atas:
Letak tinggi: duodenum sampai jejunum
Letak rendah: kolonsigmoidrectum
Obstruksi letak tinggi dan letak rendah di batasi oleh iliocecal junction
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ILEUS PARALITIK
Ileus paralitik merupakan suatu keadaan dimana usus gagal atau tidak mampu
melakukan kontraksi peristaltik untuk menyalurkan isinya. Ileus paralitik disebutjuga ileus adinamik atau non mekanik.
Etiologi Ileus Paralitik :
1. Trauma abdomen
2. Pembedahan perut (laparatomy)
3. Rongga perut
Radang usus buntu
Devertikulitis
Nefrolisiasis
Kolesistitis
Pankreatitis
Perforasi Ulkus Duodenum
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Yang dapat ditemukan pada pemeriksaan foto abdomen ini antara lain :
Dilatasi di proximal sumbatan (sumbatan paling distal di ileocecal junction)dan kolaps usus di bagian distal sumbatan.
Coil spring appearance
Herring bone appearance
Air fluid level yang pendek-pendek dan banyak (step ladder sign)
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Herring Bone
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Dilatasi usus Keseluruhan
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Dilatasi usus Keseluruhan
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Multipel air fluid leveldan
string of pearls sign
(gambaran beberapa kantung
gas yg berderet)
Coffee bean appearan( b l
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(gambaran gelung us
distensi&terisi udara, d
gelung usus berbentuk
Ileus Paralitik. Tampak dilatasi usus
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Ileus Paralitik. Tampak dilatasi ususkeseluruhan
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1. Penebalan usus halus yang mengalami dilatasi memberik
gambaran herring bone appearance, karena dua dindingusus halus yang menebal dan menempel membentukgambaran vertebrae dan muskulus sirkuler menyerupaikosta.
2. Tampak gambaran air fluid level yang pendekpendek atadisebut step ladder appearance karena cairan transudasiberada dalam usus halus yang mengalami distensi.
3. Pada ileus paralitik terdapat penebalan dinding usus secamenyeluruh dari gaster sampai rektum.
Pada ileus :
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Small Bowel Obstructions
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Small Bowel Obstructions
Dilatasi usus kecil
Gambaran coil spring dan herring bone
Udara dalam colon minimal, terutama di daerahrectum
Multipel air fluid level pendek Causa : Adhesi, volvulus, gallstone ileus.intusupsesi
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SBO
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Coil sprin
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Large Bowel Obstructions
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
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Supine Prone