RADIOLOGI GAWAT

ABDOMEN
Anatomy Abdomen
Anatomy Abdomen
Anatomy Abdomen
Calculi
Calculi

Staghorn pada Ginjal

Small Bowel Obstruction (SBO)
 Small Bowel Obstruction (SBO)

Supine View Erect View Lateral Decubitus View

Small Bowel Obstruction (SBO)

Posisi Erect Posisi Supine

Small Bowel Obstruction (SBO)

Coiled Spring Sign

String of Pearl Sign
Small Bowel Obstruction (SBO)

Coiled Spring Sign

Small Bowel Obstruction (SBO)

String of Pearl Sign

Small Bowel Obstruction (SBO)

Strech/Slit Sign
Large Bowel Obstruction (LBO)

Supine View Erect View

Large Bowel Obstruction (LBO)

Supine View Erect View

Large Bowel Obstruction (LBO)

String of Pearl
Large Bowel Obstruction (LBO)
 SBO VS LBO
SMALL BOWEL OBSTRUCTION LARGE BOWEL OBSTRUCTION
• Dilatasi di proksimal sumbatan • Dilatasi usus halus dan kolon proksimal sumbatan
• Distribusi di sentral • Distribusi di perifer
• Di proksimal ileocaecal junction • Sumbatan di kolon
• Kolaps usus di distal sumbatan • Kolaps usus di distal, gambaran udara di kolon
sigmoid dan rektum menghilang
• Penebalan dinding usus halus (Hearing Bone • Hearing Bone Appearance
Appearance)
• Step Ladder Appearance (air fluid level pendek- • Step Ladder Appearance dan Air Fluid Level
pendek) panjang-panjang di kolon
• Gambaran Valvula Conniventes • Gambaran Haustra
• Gambaran String of Pearl
• Coiled Spring Apperance
SBO VS LBO
Cecal Volvulus
Sigmoid Volvulus
Sigmoid Volvulus
Sigmoid Volvulus
Cecal VS Sigmoid
Volvulus
 Intussusception
• Invagination segmen of proximal bowel into distal bowel

• Type :

a) Ileocolic (90%)

b) Ileo-ileocolic

c) Ileo-ileal

d) Colocol

• Clinical Presentation :

1. Classic Triad :

a) Intermittent colic pain

b) “Red Currant Jelly” Stools

c) Vomiting

2. Palpable abdominal mass

3. Drowsiness and lethargy

 Intussusception
• Abdominal Radiograph

1. RLQ and RUQ

• Absence of air (Crescent Sign)

• Soft tissue mass (Target Sign)

2. Small bowel obstruction with air fluid level

3. Normal in >50% of cases

Intussusception

RUQ Mass
 Intussusception

Crescent/Meniscus Sign
 Intussusception
Target Sign : RUQ Mass, sometimes looks like target

Target Sign
 Pneumoperitonium : The 14 Signs
1. Anterior Sub Hepatic Space 9. Double Bubble Sign

2. Doges Cap Sign/Morrison’s Pouch Free Gas 10. The Cupola Sign

3. Air anterior to ventral surface liver 11. Lesser Sac Gas

4. Rigler’s Sign 12. The Triangle Sign

5. Decubitus abdomen sign 13. Abscess Gas

6. Falciform Ligament Sign 14. Pneumoretroperitoneum

7. The Football Sign

8. Continous Diaphragm Sign

 Pneumoperitonium : The Other Sign
1. Urachus Sign

2. Leaping Dolphins Sign

3. Inverted V Sign

4. Ligamentum Teres Sign

Anterior Sub Hepatic Space Free Air
Supine ; Liver Sign 1
Linear Shape
Doges Cap Sign/Morrison’s Pouch Free Gas
• Doges Cap Sign refers to the air in Morrison’s
Pouch.
• Morrison’s Pouch is normally a potential space
between the right kidney an the liver.
• Gas in Morrison’s Pouch may have the following
features :
1) Triangular in shape
2) Concave medial border
3) Positioned inferior to the right 11th rib
4) Positioned superior to the right kidney

Supine
Doges Cap Sign/Morrison’s Pouch Free Gas
• Morrison’s pouch free gas demonstrated on supine radiographs
typically show the following characteristics :
1. Typically triangular shape
2. The lower lateral corner in commonly sharp
3. The lateral border in typically concave and outlines the medial
border of the liver
4. Inferior to the 11th rib
5. Superior to the right kidney
Air anterior to ventral surface liver
• Air sitting against the ventral suface of the liver can be any shape
and, as in this case, is frequently “Geographical” in shape.
• Posisi : Supine
Rigler’s Sign

• The sign refers to the appearance of the bowel wall on plain film
when it is outined by intraluminal and extraluminal air (arrowed). The
extraluminal air is free peritoneal gas.
• Posisi : Supine
Decubitus abdomen sign

• White arrow : free air between the abdominal wall and the liver
• Black arrow : free fluid in the peritoneum
• Posisi : Left Lateral Decubitus
Falciform Ligament Sign

• Falciform Ligament :
 Connects the anterior abdominal wall to the liver
 Extends inferiorly beyond the liver  becomes round
ligament
 Becomes outlined with air in a patient with free abdominal
gas
• Posisi : Supine
The Football Sign

• Massive air filled peritoneum

Continous Diaphragm Sign

• Massive pneumoperitoneum  sufficient air beneath

diaphragm
• Left and right hemidiaphragm contrased by the free gas appear
as a continous structure
The Cupola Sign

• Dome like
• Refers to an air accumulation beneath the central tendon of the
diaphragm (white arrows)
Lesser Sac Gas

• Lesser sac sign (Black Arrows)

• Cupola Sign ( White Arrows)
• The lesser sac is positioned posterior to the stomach and is
usually a potential space
The Triangle Sign

• Small triangles of free gas positioned between the large bowel

and the flank
Abscess Gas

• Arrowed bubbles of gas Not clearly contained within normal

hollow abdominal viscus
- Not aligned in a linear fashion nor outline normal haustral
features
Pneumoretroperitoneum

• Posisi : Supine
• Air seen surrounding the lateral border of the kidney
(retroperitoneal organs)
• If the gas seen to move in a erect, and decubitus view, its NOT in
the retroperitoneum
Urachus Sign

• Air contrasted urachus

• Vertical line between bladder and umbilicus
• Outline of medial umbilical ligament
The Inverted V Sign

• Air under hemidiaphragm and diaphragmatic muscle slips visible

Ligamentum Teres Sign

• Extraluminal air in the fissure for the ligamentum teres

• Linear density running along the inferior edge of