kuliah blok gi tract-ct scan abdomen_agustus 2010

7/27/2019 Kuliah Blok GI Tract-CT Scan Abdomen_Agustus 2010

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Dr. Yanto Budiman, Sp.Rad., M.KesBagian Radiologi FK/RS Atma Jaya

Jakarta


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Pelvis Female


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Liver

Billiary system

Gall bladder

Pancreas

Spleen

Stomach

Intestine Colon


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Liver. Horizontally subdivided by the main branches

of the portal vein into cranial and caudal part.

The main hepatic vein mark the borders of thesegments in the cranial part.

The border between the left and right lobes is

marked by the plane between the middle

hepatic vein and gallbladder fosaa


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Hepatic Cysts Simple hepatic cyst Hydatid cyst

Hepatic metastases Solid hepatic lessions

HemangiomaAdenoma Focal Nodular Hyperplasia

Diffuse hepatic changes Fatty Liver Hemochromatosis Cirrhosis


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Containing serous fluid are sharply defined,

thin walled, homogenous lesions with density

values close to water

Benign cysts do not show any significant

enhancement after i.v CM.


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Cyst


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Multiloculated appearance, with radially

aranged septations between different

cysts.

Mostly affected right lobe, sometimes the

left lobe or the spleen become involved.

Partial or complete wall calcification is

frequent.


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spleen

Liver

multiloculated

Hydatid cyst


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Multiple focal lesions suggest liver

metastases

Common originate from colon, lung ,

breast , kidney and uterus

enhanced is obtained in venous and early

arterial phase.


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Venous phase Early arterial phase


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The most common benign hepatic lesion.

In unenchaned images : well defined

homogeneous areas of decreased

attenuationAfter injection CM : enhancement begins in

the periphery and progresses toward the

centre of hemangioma


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Occurs in women, age 20-60, long history

of taking oral contraceptives.

Originate in hepacotcytes.

Usually isodense, sometimeshypervascular, and may be accompanied

by hipodense infarction, central necrosis,

and/or hemorrhage.


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Do not show any tendency of malignant

degeneration.

On unenhanced images : appear as

hypodense, sometimes isodense, well-defined lesions

After i.v CM : an irregularly shaped,

hypodense central area


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Pneumobilia

Cholestasis


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Gas in the billiary tract.(fig 124.4) Common causes: sphincterotomy, ERCP, surgical

choledohoenteric anastomosis.

Hypodense gas within intrahepatic bile ducts.


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Cholestasis (fig 124.5) Common causes : gallstone, pancreatic

carcinoma

Diagnosis been made if the diameter > 5 cm inseveral transverse planes


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cholestasis


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Cholecystolithiasis

Chronic Inflammatory lesions


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Cholecystolithiasis Has different patterns of calcification

Cup shapes calcification : cholesterol

Ring calcification : billirubin stone.


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Splenomegaly Caused by : portal hypertension,

leukemia/lymphoma, myelofibrosis, and hemolytic

anemia. Normal splenic size (in transverse plane) : length

< 10 cm and width < 5cm

Craniocaudal dimension < 15 cm.

Development of splenomegaly : Crescent shape is lost, displace adjacent organ (left

kidney compressed), infarction


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Splenic cysts : characteristics of hepatic cysts Metastases in the spleen : rare , difficult to

distinguish from cyst (fig 127.3)

Splenic candidiasis : multifocal lesions w/inhomogenous CM enhancement, ascites Splenic lymphoma : diffuse infiltration an

spleen appear normal.

Blunt trauma : hematomas beneath capsule,delayed rupture of the capsule.(fig 127.5)


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Acute and Chronic Pancreatitis

Pancreas Neoplasms


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Acute pancreatitis : Blurring of pancreatic contour, lobbular patern of

pancreas is effaced.

Hypodense pancreatic fluid and edema of theconnective tissue


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Most common located in head of the pancreas

Even small tumors may cause cholestasis- obstructing

the Common Bile Duct.

Tend to metastasize to the liver and theregional lymph nodes

Islet cell tumors, 75 % of which are

functional, located within the body of

pancreas.


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Hypo-dense CM : water with complement :Endoscopy and Endosonography.

In Carcinoma of stomach : Focal (fig

139.1)or Diffuse wall Thickening(fig.139.2). Finding intraperitonial gas (fig 139.3): suggest

small perforation occuring with ulcers or advance

ulcerating carsinomas dd/: Leiomyoma, lymphoma and leiomyosarkoma

of the stomach


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Inflammation of the intestines Examined thickening wall : Ulcerative colitis

(fig139.4) and Chrons disease (fig 139.5)

DIC or over-anticoagulation : hemorrhagein the bowel wall and mural thickening (fig

139.6a) dd/ Ischemia, as a result of

atheroslerosis od embolus


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kuliah blok gi tract-ct scan abdomen_agustus 2010

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