TENTIRAN KOAS

PEMERIKSAAN
RADIOLOGI
GASTROINTESTINAL

Adimas Okto Nugroho

 GI IMAGING
•Plain Film
•Contras studies
•Ultrasound
•CT Scan
•MRI
•Nuclear Scintigraphy
 PLAIN FILM
APA SAJA YANG DINILAI PADA FOTO POLOS
ABDOMEN ?
• Preperitoneal fat line
• Psoas line
• Pola udara dalam saluran cerna
• Adanya udara bebas
• Soft tissue mass(+)/(-)
• Kalsifikasi (+) / (-)
• Tulang
PLAIN FILM
Pneumoperitoneum
Appendicitis
Ileus Obstruktif
Ileus paralitik
Volvulus
Cholecystitis Akut
Cholelithiasis
 Normal Pankreatitis
pankreas Akut
Intususepsi /
Invaginasi
ASCITES
ORGANOMEGALI
 SIALOGRAPGY
• Indications :
• suspected sialolithiasis or salivary duct obstruction
• suspected sialadenitis: to identify ductal strictures
• suspected sialectasis in chronic inflammatory
disorders and autoimmune diseases

• Types of sialography :
• conventional/fluoroscopic sialography
• CT sialography (ultrafast technique)
• MR sialography
SIALOGRAPHY
OMD (OESOPHAGUS –
MAAG – DUODENUM)

BARIUM MEAL

BARIUM SWALLOW
Achalasia
Achalasia

"bird-beak" at LES on esophagram

STRIKTUR ESOFAGUS
Esophageal Diverticula
 Zenker’s diverticula

Killian's triangle is formed posteriorly

between the junction of the cricopharyngeus
muscle and the lower border of the inferior
constrictor muscle and is the site of origin of
Zenker's diverticulum.
 Zenker’s diverticula
• The fluoroscopic barium esophagram is the
primary tool for the diagnosis of Zenker
diverticulum.
• The diverticulum appears as an outpouching
arising from the midline of the posterior wall of
the distal pharynx near the pharyngoesophageal
junction.
• This is best identified during swallowing and is
best seen on the lateral view, on which the
diverticulum is typically noted at the C5-6 level.
• When the diverticulum is large enough to
protrude laterally, it protrudes to the left in 90%
of the cases.
• After the contrast agent bolus passes the upper
esophagus, the diverticulum is typically seen
extending posterior to the cricopharyngeus
muscle, and contrast material that was trapped
within the diverticulum may be regurgitated back
www.radiology.vcu.edu into the hypopharynx.
 Diverticula of the esophageal body

Traction diverticulum

Developmental diverticulum
Diverticula of the esophageal body

Midesophageal
diverticulum
Diverticula of the esophageal body

Midesophageal
and epiphrenic
diverticula
Diverticula of the esophageal body

Epiphrenic diverticulum
Esophageal Varices
Esophageal Varices

Barium study

Esophageal varices appear as tortuous,

serpiginous, longitudinal filling defects
projecting into the lumen of the
esophagus.
These defects are seen best on relief
projections of the esophagus.
 Esophageal Varices
CT findings

post contrast axial

and coronal
reconstructed
images
esophageal varices
and splenomegaly

From: http://home.earthlink.net/~radiologist/tf/120604.htm
CA ESOFAGUS
 Hiatal Hernia
Diaphragmatic hernias may be congenital or acquired.
Acquired hiatal hernias are divided further into nontraumatic and traumatic
hernias. The most common types of hernias are those acquired in a
nontraumatic fashion.
Hernias acquired in a nontraumatic fashion are divided into 2 types:
1. sliding hiatal hernia
2. paraesophageal hiatal hernia.
A mixed variety is possible.

Approximately 99% of hiatal hernias are sliding, and the

remaining 1% are paraesophageal.
 Hiatal Hernia - Imaging Studies
CT Findings
• Hiatal hernias often are seen
Sliding hiatal hernia
incidentally on CT scans
obtained for other indications.
• A hiatal hernia appears as a
retrocardiac mass with or
without an air-fluid level. The
mass usually can be traced
into the esophageal hiatus on
sequential cuts.
• Herniation of omentum
through the esophageal hiatus
may result in an increase in
the fat surrounding the lower
esophagus.
Mediastinal window of enhanced CT
scan obtained at the level of the
suprahepatic inferior vena cava shows
that the thorax contains a portion of
stomach (arrows). The aorta is
displaced to the right
 Gastric Ulcer
Radiologic features
If the rim of mucosa becomes edematous, a wider radiolucent band or ulcer collar may
be observed.

Posterior-wall ulcer - an ulcer collar is seen

as a radiolucent halo surrounding the ulcer

Lesser-curve ulcer - spot radiograph

 Gastric Ulcer
Radiologic features radiating mucosal folds (arrows)
Retraction of the gastric wall adjacent to
lesser-curve ulcers may lead to the
formation of smooth, symmetric folds that
radiate from the ulcer crater

The gastric mucosal folds tend to radiate outwards

from the margin of the ulcer - this is the result of
the fibrosis which occurs in the base of a long
standing chronic ulcer.
 Gastric Ulcer
CAT Scan
30-year-old man with suspected
pancreatitis. CT scan reveals
benign gastric ulcer in lesser
curvature (arrow).

From: AJR 2000; 174:901-913 Helical CT in the Evaluation of the Acute Abdomen. Richard M. Gore et al.
 Duodenal Ulcer
Radiologic features

1. small, round/ovoid/linear ulcer niche

The specimen includes the

distal part of the gastric
antrum, the pylorus and
A 1 cm irregular ulcer crater in the duodenal bulb on air proximal duodenum.
contrast spot films with patient in the right posterior
On the posterior wall of the
oblique position
duodenum there is an ulcer
3 cm in greatest diameter.
 Duodenal Ulcer
Radiologic features

1. small, round/ovoid/linear ulcer niche

This is a 76 y.o. man with nausea

and abdominal pain who
underwent a barium study shown
above.
The series reveals a small, ovoid
ulcer in the duodenal bulb
(retained barium in the ulcer
crater).
The majority of gastric and
duodenal ulcers are single.
 Complications of Peptic Ulcer
Gastric outlet obstruction

Barium upper GI studies are

very helpful because they
can delineate the gastric
silhouette and demonstrate
the site of obstruction.
An enlarged stomach with a
narrowing of the pyloric
channel or first portion of the
duodenum helps
differentiate GOO from
gastroparesis.

Contrast study demonstrating a

grossly distended stomach with
absence of distal intestinal gas due
to outlet obstruction
FOLLOW THROUGH
CHOLANGIOGRAPGY
APPENDICOGRAPHY
COLON IN LOOP / BARIUM ENEMA
CHRONIC ULCERATIVE COLITIS
“Lead Pipe Appearance”
DIVERTIKULOSIS
MALIGNANT RECTAL POLIP
COLON IN LOOP / BARIUM ENEMA
LOPOGRAFI
Liver Metastasis Ultrasound
LIVER ABSCESS ULTRASOUND
NORMAL VS CA PANCREAS
ULTRASOUND
ABDOMINAL CT SCAN
ABDOMINAL CT SCAN
ABDOMINAL CT SCAN
ABDOMINAL CT SCAN
 MRCP
(MR CHOLANGIOPANCREATOGRAPHY)
MRCP
CHOLANGIO CA
TERIMA KASIH