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Bagaswoto Poedjomartono

Dr., Sp.Rad(K)., Sp.KN., MKes., FICA.


Dept. of Radiology Faculty of Medicine
GMU / Dr. Sardjito GH Yogyakarta
 X-ray konvensional dengan / tanpa kontras
 USG
 DSA
 CT-Scanning
 Magnetic Resonance Imaging (MRI)
 SPECT
 PET
JENISNYA:
 Hemoragi
 Non Hemoragi

PEMERIKSAAN:
 CT- Kepala / Brain CT-Scan
 Magnetic Resonance Imaging / MRI
 Brain SPECT
 Brain PET
 Arteria cerebri media
dan arteria cerebri
anterior
 Hemiparesis,
homonymous
hemianopia , salah
satu dari higher
disfunction (
dysphasia, dyscalculia,
visuospatial disorder)
 Infark cortical karena
oklusi bagian atas
atau bawah dari
arteria cerebri media
 Dua dari
Hemiparesis,
homonymous
hemianopia , higher
disfunction
 Infark di otak yang diperdarahi oleh arteria
perforating atau internal border zone
 Infark kecil ( tdk lebih 1,5 cm ) di ganglia basalis
atau di pons
 Infarct di daerah yang
diperdarahi arteria
cerebri posterior dan
arteria
vertebrobasilaris
 Cerebellum, lobus
oksipitalis dan batang
otak
Intracerebral hemrrhage
CT AND MRI
1. Foto polos abdomen
2. Ultrasonografi
3. Doppler Ultrasonografi
PELURU
 Foto polos pada tempat yang terkena posisi AP dan Lateral
dan jika perlu ditambah dengan posisi lainnya.
 Pemeriksaan dengan kontras untuk mengetahui arah
jalannya peluru

UANG LOGAM (dlm sal makanan)


 Foto polos leher, thorax dan abdomen, tergantung sampai
dimana korpal tersebut berada. Posisi AP dan lateral.
 Kalau perlu dengan kontras positip
Bila letak corpal transversal obliq: di trachea
NORMAL HEAD INJURY
For contrast exami
nation:
1. OMD
2. Barium FT
3. Colon inloop
4. Myelography
5. Plebography
6. Etc
The differential diagnostic conclusions which can
be drawn from contrast enhancement are based
on certain criteria:
 The pattern of contrast enhancement (homogenous, patchy, ring-
shaped, etc.).
 The quantitative level of contrast enhancement, and
 The temporal causes of the accumulation of contrast material
(kinetics), which is recorded by means of repeated measurements.
Intestinal ilius
Staaghorn stone at the
Right and Left kidneys
For NM exami
Nation:
1. Bone scan
2. Liver scan
3. Thyroid scan
4. Renogram
5. Etc
 Changes in mucosal folds
 Changes in wall thickness
 Changes in caliber
 Presence of ulceration
 Presence of filling defect(s), or
 Presence of mesenteric involvement
 Distended small bowel (central position)
 Multiple loops and valvulae conniventes
(string of beads sign, which due to bubbles of
gas trapped between fold of valvulae
conniventes)
 Non-dilated ascending colon (non-dilated large
bowel)
 Mechanical obstruction
 Strangulating obstruction
 Volvulus of the small intestine
 Gallstone ileus
 Intussusception
 Mesenteric thrombosis – small intestine
infarction
 Incomplete or complete small bowel
obstruction
 Gas within the gallbladder and/or bile duct
 Abnormal location of a gallstone
 Change in position of a gallstone
 Relatively large fluid gas ratio in distended
loops
Small bowel Large bowel

 Haustra Absent present


 Valvulae conniventes present in jejunum absent
 Number of loops many few
 Distribution of loops central peripheral
 Radius of curvature of loops small large
 Diameter of loops 30-50mm 50mm+
 Solid faeces absent may be present
 Pleurisy
 Pneumonia
 Pulmonary infarction
 Myocardial infarction
 Leaking or dissecting thoracis aneurysm
 Congestive cardiac failure
 Pericarditis
 Pneumothorax
 Gallstone fistula (gallbladder usually small)
 Following biliary surgery or endoscopic
sphincterotomy)
 Following percutaneous or endoscopic
cholangiography)
 Malignant fistula
 Perforated peptic ulcer (into bile duct)
 Emphysematous cholangitis (gallbladder usually
enlarged)
 Physiological, due to lax sphincter
 Mechanical
 Large bowel volvulus
 Caecal volvulus
 Sigmoid volvulus
 Acute colitis
 Toxic megacolon
 Ischemic colitis
 Paralytic ileus
 Pneumoperitoneum
 Acute appendisitis
 Acute cholecystitis
 Acute pancreatitis
 Intra abdominal abscesses
 Renal colic
 Leaking abdominal aortic aneurysm
 Acute gynaecological disorders
GASTROINTESTINAL
BLEEDING
Case: 61-year-old man
with melena for 5 days.

Non-Contrast MSCT

Contrast MSCT:
• Distended gaster with airfluid level
• Asites in perihepatic and
perisplenic
space
•Extravasasi contrast media in lumen
of gastric anthrum
(A) Posteroanterior celiac arteriogram
and (B) right gastric arteriogram with a
microcatheter reveal active bleeding
(arrows) from the right gastric artery.
Arrowheads show hemoclips used for
endoscopic hemostasis.

Right gastric arteriogram with a


microcatheter reveal active bleeding
(arrows) from the right gastric artery.

B
Case: 62-year-old woman
with massive hematochezia

Non-Contrast
MSCT

Contrast MSCT:
•Unenhanced fluid level in the
small bowel loop.
• Extravasasi contrast in the
small
bowel lumen
Case: 62-year-old woman
with massive hematochezia

DSA angiography:
Shows extravasated
contrast material in the
active bleeding from
posterior superior
mesenteric arteri in the
distal ileum
Case: 71-year-old man with
massive hematochezia.

Non-Contrast MSCT
Unenhanced CT shows fluid
level filled in the colonic loop
without opasitasion in the
right lower quadran of the
abdomen

Contrast MSCT
Shows highly attenuating
extravasated contrast material
in the lumen of asending colon
Case: 71-year-old
man with massive
hematochezia.

DSA angiography shows


posterior superior
mesenteric arteri reveals
multiple pseudoaneurism
with active bleeding in the
cecum