ABDOMEN

By : dr.Ifada Indriyani Sp.Rad

 Key to densities in Abdominal
X Ray

 Black: gas
 White: calcified structures
 Grey: soft tissues
 Darker grey: fat
 Intense white: metallic objects
Foto polos
Abdomen
 Cara membaca Foto Abdomen :
( BNO )
• Bayangan gas usus normal bercampur fecal
material
• Bayangan hepar dan lien tak tampak
membesar
• Contour ginjal kanan kiri dalam batas normal
• Tak tampak bayangan radioopaque
sepanjang traktus urinarius
• Psoas shadow kanan kiri simetris
• Corpus, pedicle dan spatium intervertebralis
tampak baik
 Nerolithiasis
Tampak opasitas
bentuk bulat
diproyeksi setinggi VL
2 sisi dextra

Kesan :
Nefrolithiasis dextra
setinggi VL 2
 Ureterolithiasis
Tampak opasitas bentuk
bulat diproyeksi setinggi VL
4 sisi sinistra

Kesan :
Ureterolithiasis sinistra
setinggi VL 4
Vesicolithiasis
Tampak opasitas
bentuk bulat
diproyeksi cavum
pelvis

Kesan :
Vesikolithiasis
DIVERTICEL BLADDER
TAMPAK
ADDITIONAL
DEFECT BENTUK
KANTUNG DI
BLADDER,
BENTUK BULAT,
BATAS TEGAS
Anatomi Bowel
Abdomen dengan kontras
Small Bowel
 Large bowel

• Colon with barium contrast

 Cara membaca Foto Abdomen 3 posisi :

• Bayangan gas usus tampak normal dengan

distribusi merata pada usus halus dan usus
besar
• Tak tampak gambaran coilled spring/herring
bone sign
• Tak tampak gambaran udara bebas sub
diaphragma dan suprahepatal
• Tak tampak gambaran step ladder
pathologis
• Pre peritoneal fat line tak tampak kelainan
 BLACK SHADOWES
‘BLACK SHADOWS’ = GASSES

 Intra-luminal gas can be normal.

• Extra-luminal gas is abnormal.

• However, intra-luminal gas can be abnormal if it is

in the wrong place or if too much is seen.
• The maximum normal diameter of the large bowel is
55mm.
• Small bowel should be no more than 35mm in
diameter.
 Places to look for abnormal extra-
luminal gas

Under the diaphragm

 In the biliary system
 Within the bowel wall
 Causes of Extra-luminal gas:
1. Post Abdominal Surgery/ERCP
2. Perforation of viscous (e.g.. bowel, stomach)
3. Gallstone ileus
4. Cholangitis ( infection with gas forming
organisms)
5. Abscess

 An erect CXR (not AXR) is the best projection

to diagnose a pneumoperitoneum (gas in the
peritoneal cavity).
Small Bowel Obstruction
 Small Bowel Obstruction
• Tampak dilatasi sistema usus bagian
central
• Tampak COIL SPRING, HERING BONE
• AIR FLUID pendek ( jumlah > 5).
• Tak tampak udara di cavum pelvis
• Tak tampak gambaran
pneumoperitonium
Large bowel Obstruction
 Large bowel Obstruction
• Tampak dilatasi sistema usus bagian
perifer
• Tampak gambaran HAUSTRA dan
INCISURA.
• AIR FLUID LEVEL panjang ( jumlah < 3)
• Tampak gas rectum
DIVERTICEL DUODENUM
TAMPAK
ADDITIONAL DEFECT
BENTUK KANTUNG DI
DUODENUM,
SOLITER, BULAT,
BATAS TEGAS,.
 APPENDICITIS

 PLAIN
: TAMPAK OPASITAS DI PROYEKSI ILLIACA
DEKSTRA ( APPENDICOLITH )

 USG : TAMPAK PENEBALAN DINDING APP > 6 MM.

 PADA CF TAMPAK PENINGKATAN VASCULAR
CIRCUMFERENTIAL.
ASCITES
- TAMPAK BULGING DI FLANK.
- TAMPAK GROUNDGLASS
OPASITY INTRA ABDOMEN.
- TAMPAK FLOATING SIGN.
WHITE Shadows
:
WHITE SHADOWS’ = Calcification
Renal Stones
Renal Stones
STAGES OF
HYDRONEPHROSIS
HYDRONEPHROSIS & HYDROURETER
Kidneys ureters and stones
 RENAL STONES
Pancreatic Calcification
 GREY SHADOWS:

GREY SHADOWS’ = Soft Tissues

Soft tissues represent most of the contents of the

abdomen and feature heavily in the AXR. However,
these tissues are poorly seen when compared to
other imaging techniques such as ultrasound or CT.

The kidneys, spleen, liver and bladder (if filled) can be

seen in addition to psoas muscle shadows and
abdominal fat. Rarely would action be taken on the
basis of this imaging alone.
Splenomegaly
Psoas muscle
BRIGHT WHITE SHADOWS:
Foreign Bodies represent an interesting
final observation . Objects that may be
seen include ingested foreign bodies ,
items in the path of the x-ray beam such
as belt buckles, dress buttons and jewelry .
Other objects may have been deliberately
placed for example an aortic stent, an
inferior vena cava filter or a suprapubic
urinary catheter.
Sterilization clips and an intra-uterine
device are common findings in women.
‘BRIGHT WHITE BITS’ = Foreign Bodies

Foreign Bodies represent an interesting final

observation . Objects that may be seen include
ingested foreign bodies , items in the path of the
x-ray beam such as belt buckles, dress buttons and
jewelry . Other objects may have been deliberately
placed for example an aortic stent, an inferior vena
cava filter or a suprapubic urinary catheter.
Sterilization clips and an intra-uterine device are
common findings in women.
Terima kasih
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