radiologi bedah kelompok b

8/13/2019 Radiologi Bedah Kelompok b

1/14

RADIOLOGI BEDAH

KELOMPOK B1. Sebutkan tujuan utama analisis foto radiografi pada kasus tumor tulangMembedakan suatu tumor bersifat benigna atau maligna. Cirinya:

Benign: batas tegasMaligna: periosteal maligna, kalsifikasi soft tissue, bisa

osteoklastik/osteoblastikMembedakan origin tumor, apakah berasal dari soft tissue yang merusaktulang atau sebaliknya

Penyebaran ke tulang yang lain monoostosis! bila berasal dari tulang,jarang ke tulang lain, seringnya metas ke paru, ke"uali dari jaringan lunakjoint! bisa merusak banyak tulang disekitarnya.

#nduh: "lues and "ues bone tumor.ppt$. Sebutkan tanda tanda radiografi benign tumor tulang

Sumber:%e"ture dr. &ahadyanhttp://'''.imageinterpretation."o.uk/tumour.html

1. ()( )SS*+*(- +*B&)M fibrous "orti"al defe"t!

0ray finding radiolu"ent area 'ith border around dense )ne of the most "ommon benign lyti" lesions seen symptomati" and usually an in"idental finding Metaphyisis of the long bone Most often seen around the knee and distal tibia (on)ssifying fibroma generally bigger than $"m

+ibrous Corti"al 2efe"t generally smaller than $"m rises in under 34 year age group 2e5elops from "orte6 of metaphysis7 is e""entri" 'ithin the bone Bubbly #sually has thin, s"leroti" border that is often s"alloped and slightly e6pansile Be"ome s"leroti" as healing o""urs and 8disappears9 as it ossifies herefore not seen in o5er 34 age group

$. +*B&)#S 2SP%S* rabe"ular bone repla"ed 'ith fibrous tissue

&adiologi" findings Cysti" rea in the metaphysis / diaphisis of the bone 8ground glass9

%ong lesion in a long bone often o""urs in pro6imal femur!
http://www.imageinterpretation.co.uk/tumour.htmlhttp://www.imageinterpretation.co.uk/tumour.html


2/14

;6pansion and bone deformity %yti" but be"omes groundglass in appearan"e as the matri6 "al"ifies, and

then be"omes s"leroti" symptomati", but "an fra"ture (o periosteal rea"tion May be single or multiple lesion in different lo"ations

3. )S;)*2 )S;)M

&adiologi" +indingsSmall radiolu"ent area 8 (*2#S 8 22: brodies abses


3/14

Maffu""i@s Syndrome A Multiple en"hondromas 'ith soft tissuehaemangiomas

Contain "al"ified "hondroid matri6 irregular, spe"kled! 'hen lo"ated a'ayfrom phalanges

. )S;)C=)(2&)M umor at the distal of the physeal plate . Metaphysis area.

&adiologi" findingsumor at the metaphysis area

. SMP%; B)(; CS rises in under 34 year age group Presents 'ith pain ;6pansile 2ifferential diagnosis: osteoblastoma, as 5ery similar in appearan"e

&adiologi" findings: Stri"t border. %u"ent area at meta and physeal pl. hinning of the "orte6.

D. (;#&SM% B)(; CS rises in under 34 year age group Presents 'ith pain


4/14

;6pansile 2ifferential diagnosis: osteoblastoma, as 5ery similar in appearan"e

&adiologi" findings%u"ent area 'ith stri"t border.


5/14

E. -*( C;%% #M)&. ;piphyses must be "losed Must be epiphyseal and abut the arti"ular surfa"e >elldefined 'ith narro' ?one of transition

Must ha5e a nons"leroti" margin ;""entri" 'ithin the bone #sually o""urs 'ithin the distal femur or pro6imal tibia 1per "ent be"ome malignant based on re"urren"e rate or subseFuent

metastases&adiologi" findings

8 soap buble appearen"e9. 8 ballooned 8 thinning of the "orte6 . Pushing the surrounding of soft tissue.

3. Sebutkan 3 tanda sign ! temuan radiografi abdomen 3 posisi pada kasuske"urigaan perforasi

1. foot ball sign: gambaran pneumoperitoneum luas di ka5um abdomenhanya bila udara massif, biasanya disertai < tanda lainya.$. double 'all sign/rigler sign: udara di kedua sisi abdomen butuh 1444 mlgas dan "airan intraperitoneal!3. tell tale triangle sign: kantung udara triangular diantara 3 segmen usus&ight #pper Fuadrant gas:

Single large area of hyperlu"en"y o5er the li5er )bliFue linear area of hyperlu"en"y outling the posteroinferior li5er 2odge@s "ap sign: triangular "olle"tion of gas in morison pou"h posterior

hepatorenal spa"e! %ig. eres not"h : in5erted G shaped area of hyperlu"en"y along undersurfa"e

of li5er %ig. eres sign: air outling fissure of lig. eres hepatis Saddle bag/"upola sign: gas trapped belo' "entral tendon of diaphragm Parahepati" air: gas bubble lateral to right edge of li5er


6/14

medial displa"ement of bo'el and solid 5is"era a'ay from properitoneal

fat stripe!

bulging of the flanks

in"reased separation of small bo'el loops

he fluid "auses a generali?ed ha?iness or Iground glassI appearan"e to

the abdomen. he bo'el loops may be separated by interposed fluid and bo'el loops

assume a "entral lo"ation as they float to the highest point of the

abdomen.

. Sebutkan diagnosis banding mekoneum plug syndrome )n "on5entional radiographs

o Me"onium, being fluid density, is normally in5isible on radiographs

o *n me"onium ileus, there may be dilated loops of bo'el small bo'el!

typi"ally 'ithout airfluid le5els be"ause of the 5is"osity of the

se"retions

Bo'el distension "an a"hie5e 5ery large si?eso Bubbly appearan"e of intestinal "ontents in the right lo'er Fuadrant

)n "ontrast enema

o &eFuired to establish the diagnosis

(onioni" "ontrast agents e.g. )mnipaFue or =ypaFue! or dilute

-astrografin

+luid shifts ha5e been reported 'ith -astrografin

o Mi"ro"olon

#nderused "olon in antenatal obstru"tion

May be seen 'ith other "auses of distal small bo'el obstru"tion

o Multiple o5al filling defe"ts in distal ileum and "olon from inspissated

me"onium

)n ultrasound

o ;nlarged loops of bo'el

o Possible &%J 8mass9 representing inspissated me"onium

Differential Diagnosis

=irs"hsprung@s disease

Small bo'el atresia 'ith me"onium ileus

Meconium plug syndrome

o +un"tional immaturity of the ganglion "ells in the "olon leading to

failure to pass me"onium

o Considered same as small left colon syndrome

*mperforate anus

Oter radiology imaging for Meconium Plug !yndrome


7/14

Supine frontal 5ie' of the abdomen in a ne'born 'ithme"onium plug syndrome demonstrates multiple dilated loops of bo'el butno re"tal gas.

lateral 5ie' from "ontrast enema in a ne'borndemonstrates a normaltode"reased "aliber IemptyI distal "olon and dilatedpro6imal bo'el "ontaining multiple plugs. he "hild responded "lini"ally andradiographi"ally to a single enema.

frontal 5ie' from "ontrast enema in a patient initiallygi5en a diagnosis of small left "olon syndrome. long filling defe"t is seen inthe re"tosigmoid 'ith gradual transition to a more dilated pro6imal bo'el.

he infant failed to impro5e, and re"tal biopsy "onfirmed =irs"hsprungdisease

2ibedakan dengan barium enema. 2an C*%
http://refimgshow%283%29/http://refimgshow%281%29/


8/14

. pa persamaan gambaran radiografi plain foto pada kasus mega"olonkonginetal, ileus fungsional, left small "olon sysndromaH

-ambaran plain radiography samasama menunjukkan obstruksi letak

rendah pada mega"olon "ongenital dan left small "olon syndrome.

-ambaran plain radiography pada ketiganya menunjukkan distensi usus,

multiple air fluid le5el stepladder appearan"e!. Pada umumnya distensiusus dapat dilihat di usus halus dan usus besar, memberikan gambaran"oiled spring dan hering bone appearan"e.

D. Pada systema "olore"tal sebutkan segmen/ bagian "olore"tal yang termasukintraperitoneal dan retroperitoneal*ntraperitonealA "ae"um, "olon trans5ersum, kolon sigmoid&etroperitoneumA kolon asenden, desenden dan regtum*mplikasi pada 5ol5ulus sigmoid

E. Per definisi apa yang dimaksud ileus obstruksi letak tinggi dan letakrendahH*leus obstruksi letak tinggi ialah keadaan di mana penderita

mengalami obstruksi passage makanan yang terjadi pada usus yang

berasal dari foregut, iaitu dari pylorus gaster sampai duodenum*leus letak rendah ialah keadaan di mana penderita mengalami

obstruksi passage makanan yang terjadi pada usus yang berasal dari

hindgut, iaitu dari 1/3 distal trans5erse "olon, des"ending "olon, sigmoid,

rektum,upper part anus.

ileus letak tengah ialah keadaan di mana penderita mengalami obstruksi

passage makanan yang terjadi pada usus yang berasal dari midgut, iaitu dari

jejunum, ileum, "oe"um, 5er miform appendi6, as"ending "olon, $/3 pro6imal

tran5erse"olon!

Small bo'el upper: muntah non profuse, mid, lo'er!

K. pa gambaran yang bisa dilihat pada plain abdomen pasien dengan 5ol5ulussigmoidHCoffee been sign

14.Banana sign ditemukan pada plain abdomen pada kasus apaH intususepsi11. Sebutkan jenis periosteal reaktion proses

1! >ith slo'gro'ing pro"esses, the periosteum has plenty oftime to respond to the pro"ess. hat is, it "an produ"e ne' bone

just as fast as the lesion is gro'ing. herefore, one 'ould e6pe"tto see solid, uninterrupted periosteal ne' bone along the marginof the affe"ted bone.$! =o'e5er, 'ith rapidly gro'ing pro"esses, the periosteum"annot produ"e ne' bone as fast as the lesion is gro'ing.

herefore, rather than a solid pattern of ne' bone formation, 'esee an interrupted pattern. his interrupted pattern "an manifest itself in se5eral'ays, depending on just ho' steadily the lesion gro's. *f the lesion gro's une5enly

in fits and starts, then the periosteum may ha5e time to lay do'n athin shell of "al"ified ne' bone before the lesion takes off again onits ne6t gro'th spurt. his may result in a pattern of one or more"on"entri" shells of ne' bone o5er the lesion. his pattern issometimes "alled lamellated or IonionskinI periosteal rea"tion


9/14

3! *f the lesion gro's rapidly but steadily, the periosteum 'ill not ha5e enoughtime to lay do'n e5en a thin shell of bone, and the pattern may appear Fuitedifferent. *n su"h "ases, the tiny fibers that "onne"t the periosteum to the boneSharpeyLs fibers! be"ome stret"hed out perpendi"ular to the bone. >hen thesefibers ossify, they produ"e a pattern sometimes "alled IsunburstI or IhaironendIperiosteal rea"tion, depending of ho' mu"h of the bone is in5ol5ed by the pro"ess.

pi"t:IsunburstI and IhaironendI periosteal rea"tion!

fairly "onfident that 'e are dealing 'ith a benign pro"ess. =o' "onfidentH *n normal

e5eryday pra"ti"e, my estimate is that you "an be about K4 K "onfident in this

ruleK!, but your mileage may 5ary. s 'ith many rules in medi"ine, there are some

"a5eats asso"iated 'ith the use of this rule. he main "a5eat 'ith this rule is that

benign pro"esses and malignant pro"esses may "oe6ist. he usual 'ay that this

may manifest is 'hen there is a fra"ture or infe"tion in the same area as a tumor. *n

this "ase, you may see a fairly "omple6 pattern of periosteal rea"tion thatdemonstrates some elements that look benign and some that look 5ery aggressi5e.

1$.pa tujuan pemeriksaan "olon in loop pada kasus in5aginasiH

Colon *n loop berfungsi sebagai diagnosis "upping sign, letak in5aginasi"

Pada orang de'asa diagnosis preoperatif keadaan intususepsi sangatlah

sulit, meskipun pada umumnya diagnoasis preoperatifnya adalah obstruksi

usus tanpa dapat memastikan kausanya adalah intususepsi.

2iagnosis dapat ditegakkan berdasarkan ri'ayat yang khas dan pemeriksaan

fisik. Pada penderita dengan intususepsi yang mengenai kolon, barium

enema mungkin dapat memberi konfirmasi diagnosis. Mungkin akan

didapatkan obstruksi aliran barium pada ape6 dari intususepsi dan suatu

"upshaped appearan"e pada barium di tempat ini.

Netika tekanan ditingkatkan, sebagian atau keseluruhan intususepsi mungkin

akan tereduksi. Oika barium dapat mele'ati tempat obstruksi, mungkin akan

diperoleh suatu "oil spring appearan"e yang merupakan diagnostik untuk

ileus. Pemeriksaan penunjang lainnya #ltra sonography, Barium ;nema dan

Computed omography!

13.pa gambaran radiologi yang bisa dilihat pada periksaan head"t s"an pada kasus subara"hnoid bleedingH=igh attenuated, mengikuti lekuk dari gyrus dan sul"i


10/14

1


11/14

bright light. skin fold may mimi" the pleural line7 usually, the

patient is asymptomati" see the image belo'!.

(ote that although a skin fold "an mimi" a subtle

pneumothora6, lung markings are 5isible beyond the skin fold.

*n ere"t patients, pleural gas "olle"ts o5er the ape6, and the

spa"e bet'een the lung and the "hest 'all is most notable atthat point see the image belo'!.

large, rightsided pneumothora6 has o""urred from a rupture

of a subpleural bleb.

*n the supine position, the ju6ta"ardia" area, the lateral "hest 'all, and the

subpulmoni" region are the best areas to sear"h for

e5iden"e of pneumothora6 see the image belo'!. he

presen"e of a deep "ostophreni" angle on a supine film

may be the only sign of pneumothora67 this has been

termed the deep sul"us sign.

2eep sul"us sign in a supine patient in the *C#. he

pneumothora6 is subpulmoni".

>hen a suggested pneumothora6 is not definiti5ely

obser5ed on an inspiratory film, an e6piratory film may be

helpful. t end e6piration, the "onstant 5olume of the

pneumothora6 gas is a""entuated by the redu"tion of the

hemithora6, and the pneumothora6 is re"ogni?ed more easily.

Similar a""entuation may be obtained 'ith lateral de"ubitus

studies of the appropriate side for a possible left pneumothora6,

a right lateral de"ubitus film of the "hest should be obtained,

'ith the beam "entered o5er the left lung!.

he most "ommon radiographi" manifestations of tensionpneumothora6 are mediastinal shift, diaphragmati"

depression, and rib "age e6pansion see the image belo'!.

n older man admitted to *C# postoperati5ely. (ote the right

sided pneumothora6 indu"ed by the in"orre"tly positioned

smallbo'el feeding tube in the rightsided bron"hial tree.

Marked depression of the right hemidiaphragm is noted, and

mediastinal shift is to the left side, suggesti5e of tension

pneumothora6. he endotra"heal tube is in a good position.

ny signifi"ant degree of displa"ement of the mediastinum

from the midline position on ma6imum inspiration, as 'ell asany depression of the diaphragm, should be taken as e5iden"e of tension see the

image belo'!, although a definite diagnosis of tension pneumothora6 is diffi"ult to

make on the basis of radiographi" findings. he degree of lung "ollapse is an

unreliable sign of tension, sin"e underlying lung disease may pre5ent "ollapse e5en

in the presen"e of tension.

&ight main stem intubation resulting in leftsided tension pneumothora6, right

mediastinal shift, deep sul"us sign, and subpulmoni" pneumothora6


12/14

Pleural effusions o""ur "oin"ident 'ith pneumothora6 in $4$ of patients, but

they usually are Fuite small. =emopneumothora6 o""urs in $3 of patients 'ith

spontaneous pneumothora6. Bleeding is belie5ed to represent rupture or tearing of

5as"ular adhesions bet'een the 5is"eral and parietal pleura as the lung "ollapses

A%ELE'%A!I!

tele"tasis is the "ollapse of part or mu"h less "ommonly! all of a lung.

(indings. Mediastinal shift

1. Massi5e 'hole lung "ollapse$. %o'er lobe "ollapse

B. ra"heal 2e5iation1. >hole lung "ollapse

C. #p'ard hilar displa"ement1. #pper lobe "ollapse2. 2o'n'ard hilar displa"ement

1. %o'er lobe "ollapse;. Shift of fissures

1. ffe"ts any segment+. (arro'ing of "ostal interspa"es

1. Massi5e tele"tasisComplete atele"tasis of an entire lung see images belo'! is'hen 1! "omplete "ollapse of a lung leads to opa"ifi"ation ofthe entire hemithora6 and an ipsilateral shift of themediastinum and $! the mediastinal shift separates

atele"tasis from massi5e pleural effusion.

Complete atele"tasis of the left lung. Mediastinaldispla"ement, opa"ifi"ation, and loss of 5olume are present inthe left hemithora6.

>ith right upper lobe %! "ollapse, the "ollapsed %shifts medially and superiorly, resulting in ele5ation ofthe right hilum and the minor fissure. &arely, the %may "ollapse laterally, produ"ing a masslike opa"itythat may look like a lo"ulated pleural effusion. heminor fissure in % "ollapse is usually "on5e6

superiorly but may appear "on"a5e be"ause of anunderlying mass lesion. his is "alled the sign of-olden S. enting of the diaphragmati" pleura

ju6taphreni" peak is another helpful sign of %atele"tasis&ight middle lobe &M%! "ollapse see images belo'!

obs"ures the right heart border on a posteroanterior P! film. )""asionally, atriangular opa"ity may be obser5ed. he lateral 5ie' sho's a triangular opa"ityo5erlying the heart be"ause the major fissure shifts up'ard and the minor fissure
http://www.fpnotebook.com/Lung/Alveoli/Atlcts.htmhttp://www.fpnotebook.com/Lung/Alveoli/Atlcts.htm


13/14

shifts do'n'ard. #pon C s"anning, the atele"tati" &M% appears as a triangularopa"ity against the right heart border 'ith the ape6 pointing laterally and is termedthe Itilted i"e "ream "one sign.I

Perbedaannya: atelektasis tertarik ke hilus, pneumothorak terdorong

1D.Mengapa di perlukan foto radiografi P 5ie' dan %ateral 5ie' pada kasuske"urigaan fraktur ekstremitasH

Narena fraktur mungkin tidak terlihat pada sinar 0 tunggal dan dapat lebihmendiskripsikan karakteristik dari fraktur tersebut. Sehingga diperlukansekurangkurangnya dilakukan dua sudut pandang

1E.pa tujuan perubahan posisi pada foto abdomen plain 3 posisiHujuan perubahan posisi pada foto abdomen 3 posisi adalah untuk

mem5isualisasi se"ara maksimal areaarea yang dapat memberi gambaran

khas untuk diagnosis kelainan di abdomen. rea area yang penting tersebut

adalah:

-Posisi %eft %ateral 2e"ubitusmem5isualisasi gambaran air fluid le5el yang

panjang di kolon/ air fluid le5el pendekpendek step ladder appearan"e! pada

kasus ileus7 udara bebas pada kasus perforasi organ berongga

-Posisi supinasimem5isualisasi gambaran udara ususprominent atau normal!.

Pada kasus ileus obstruksi, tampak segmen usus yang terdistensi dengan

segmen disebelah distal dari obstruksi yang kolaps. #sus yang sangat

terdistensi dapat membentuk gambaran =earing bone appearan"e.

-Posisi Semi ;re"t/ Pmem5isualisasi areaarea seperti di infra diafragma dan

sub hepatal. Pada kasus perforasi organ berongga, area ini akan menjadi

tempat terkumpulnya udara bebas di rongga abdomen yang mudah dideteksi.

1K.Sebutkan temuan radiografi pada kasus dislokasidisaligment antar sendi, pelebaran jarakabnormal rotasi

QQQ balajar "ubiti anak$4.2oble bubble sign di temukan pada kasusH Single bubble pada kasusH

2ouble bubble sign: atresia duodenal7 single bubble sign: stenosis pilorus$1.pa yang dimaksud atresia ani letak tinggiH

tresia ani letak tinggi adalah atresia ani dimana re"tum tidak menembusmus"ulus le5ator ani, sehingga ujung buntu re"tum dengan kulit luar berjaraklebih dari 1 "m.

$$.Modalitas/ alat pemeriksaan radiologi apa yang paling tepat untuk menilaike"urigaan fraktur "er5i"alH C s"an


14/14

$3.Pada trauma abdomen dengan ke"urigaan kontusio dengan la"erasi lienmodalitas/alat pemeriksaan radiologi apa yang paling tepatH +S#S-

$

radiologi bedah kelompok b

Documents