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EMERGENSI RADIOLOGI

MODALITAS PEMERIKSAAN IMAGING PADA EMERGENSI

X-ray konvensional dengan / tanpa kontras

USG

DSA

CT-Scanning

Magnetic Resonance Imaging (MRI)

SPECT

PET

KOLIK ABDOMEN

BATU EMPEDURadiografi : Foto polos abdomen Ultrasonografi Kholeskintigrafi

BATU SALURAN KEMIHRadiografi : Foto polos abdomen Ultrasonografi Intravena Pyelografi ( IVP ) Renogram / Renoskintigrafi

ILIUS OBSTRUKSI / PARALITIKFoto polos abdomen AP, Semierect dan LLD

Ilius Obstruksi:1. Distensi usus

2. Herring bone app.

3. Air fluid level pendek-pendek.

4. Semilunar Shadow / udara bebas ( jika ada perforasi)

Ilius Paralitik1. Distensi usus

2. Air fluid level panjang-panjang

3. Udara bebas dalam cavum abdomen (jika ada perforasi)

ANGINA PEKTORIS

1. Thorax foto

2. USG Jantung

3. Myocardial Perfusion Scan

4. Doppler Colour Jantung

5. Cardiac Catheterization

STROKE

JENISNYA:Hemoragi

Non Hemoragi

PEMERIKSAAN:CT- Kepala / Brain CT-Scan

Magnetic Resonance Imaging / MRI

Brain SPECT

Brain PET

KEHAMILAN EXTRA UTERI TERGANGGU

1. Foto polos abdomen

2. Ultrasonografi

3. Doppler Ultrasonografi

KORPUS ALIENUM

PELURUFoto 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

Traumatologi

KEPALA

JENISNYA:1. Komosio serebri2. Kontusio serebri3. Laserasio serebri4. Fraktura tulang kepala

PEMERIKSAAN RADIOLOGI:1. Kepala 3 posisi: AP, Lateral, Towne’s atau Waters2. CT-kepala3. MRI4. SPECT5. PET

CT-scan otak normal

CT-scan otak dalam batas normal

Serebral hemoragi temporal kanan

Serebral hemoragi temporal kiri lateral capsula interna

Hemoragi subarachnoid

Fractura calvaria dengan epidural hematoma dan hematoma jaringan lunak kepala

Traumatologi

SISTEM SKELETAL

EXTREMITAS:Radiografi:

Posisi Anteroposterior

Posisi lateral

Posisi tambahan (k/p)

VERTEBRA:Radiografi:

1. Posisi Anteroposterior

2. Posisi Lateral

3. Posisi Oblik kanan atau kiri.

4. Posisi khusus

Corpus alienum uang logam 500 rp. Didalam oesophagus

Cont: Corpal di oesophagus distal pada oesophagogastric joint

EMERGENSI PADA TRAUMA TULANG BELAKANG

VERTEBRA CERVICALIS: Lebih sering trauma Terutama C5 – C6 Mobilitas paling besar Spinal canal 30% lebih besar dari spinal cord

VERTEBRA THORACALIS: Jarang terkena trauma Jika terkena dapat terjadi : Complete paralisis; Irreversible


VERTEBRA LUMBALIS: Trauma paling sering pada Th 12 – L 1 Paraparese sampai paraplegia

GANGGUAN NEUROLOGIS: Kompresi pada spinal cord Pembuluh darah terputus:

Sel saraf mati ( dalam 4 jam) Spinal cord terputus


FRACTURA C3 – C4: Respirasi abdominal

Lesi nervus intercostalis Sering meninggal karena gagal nafas

FRACTURA C7- Th 1 : Horner Syndrome

1. Ptosis

2. Enophtalmus

3. Anhidrosis

4. Miosis


KELAINAN PADA VERTEBRA CERVICALIS DAN THORACALIS


Fractura lumbal sebelum dan sesudah operasi

Traumatologi

THORAX

JENISNYA:1. Fraktura sistem skeletal

2. Hemothorax

3. Hidro/hemopneumothorax

RADIOGRAFI:1. Posisi AP / PA

2. Lateral

3. Right Lateral Decubitus ( RLD )

Foto thorax normal

EMERGENSI PADA GANGGUAN PERNAFASAN

Keuntungannya:

Dapat membedakan antara edema paru kardiogenik dan edema paru akibat peningkatan permiabilitas kapiler

Kerugiannya:

Kurang sensitif untuk perubahan kecil pada paru

Tidak spesifik untuk penyakityang memenuhi alveoli dan berbagai penyakit parenkhim

Foto thorax: merupakan pemeriksaan laboratorium yang paling Praktis untuk mendeteksi edema paru.

EMERGENSI PADA GANGGUAN PERNAFASAN

FEATURE:1. Heart size

2. Vascular pedicle

3. Flow distribution

4. Blood volume

5. Septal lines

6. Peribronchial cuffs

7. Air bronchogram

8. Edema distribution

9. Pleural effusion

CARDIAC:1. Enlarge

2. NI / enlarge

3. Inverted

4. NI / increased

5. Not common

6. Very common

7. Not common

8. Even / central

9. Very common

INJURY:1. Not enlarge

2. NI / reduced

3. NI / balanced

4. NI

5. Absent

6. Not common

7. Very common

8. Peripheral

9. Not common

EDEMA PARU

Pengabutan paruKanan dan kiriBatas jantung parumenghilang

PNEUMOTHORAX DEXTRA

Corakan paru kananlateral relatif kosongdan paru kolaps kemedial

PLEURAL EFFUSION SINISTRA MASIF

PERSELUBUNGAN MASIF PARU KIRIDAN SIFTED KE KANAN

ACUTE ABDOMENACUTE ABDOMEN

Intestinal iliusIntestinal ilius

The distinction between small bowel and large bowel dilatation

The distinction between small bowel and large bowel dilatation

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

Basic Radiographic Patterns of Small Bowel Pathology

Basic Radiographic Patterns of Small Bowel Pathology

Changes in mucosal folds

Changes in wall thickness

Changes in caliber

Presence of ulceration

Presence of filling defect(s), or

Presence of mesenteric involvement

INTESTINAL ILIUSINTESTINAL ILIUS

LLD POSITIONLLD POSITION

PERFORASI GI

Small bowel obstructionSmall bowel obstruction

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)

The causes of small bowel obstruction

The causes of small bowel obstruction

Mechanical obstruction

Strangulating obstruction

Volvulus of the small intestine

Gallstone ileus

Intussusception

Mesenteric thrombosis – small intestine infarction

Chest conditions which may mimic an acute abdomen

Chest conditions which may mimic an acute abdomen

PleurisyPneumoniaPulmonary infarctionMyocardial infarctionLeaking or dissecting thoracis aneurysmCongestive cardiac failurePericarditisPneumothorax

Signs of gallstone ileus Signs of gallstone ileus

Incomplete or complete small bowel obstructionGas within the gallbladder and/or bile ductAbnormal location of a gallstoneChange in position of a gallstoneRelatively large fluid gas ratio in distended loops

Causes of gas in the biliary

tree Causes of gas in the biliary

tree

Gallstone fistula (gallbladder usually small)Following biliary surgery or endoscopic sphincterotomy)Following percutaneous or endoscopic cholangiography)Malignant fistulaPerforated peptic ulcer (into bile duct)Emphysematous cholangitis (gallbladder usually enlarged)Physiological, due to lax sphincter

The causes of large bowel obstruction

The causes of large bowel obstruction

MechanicalLarge bowel volvulusCaecal volvulusSigmoid volvulusAcute colitisToxic megacolonIschemic colitisParalytic ileus

The other causes of acute abdomen

The other causes of acute abdomen

Pneumoperitoneum

Acute appendisitis

Acute cholecystitis

Acute pancreatitis

Intra abdominal abscesses

Renal colic

Leaking abdominal aortic aneurysm

Acute gynaecological disorders

Traumatologi

ABDOMEN

RUPTUR HEPAR / LIEN:


2. Abdomen 3 posisi

3. Ultrasonografi

4. CT-Scan

5. MRI

6. Hepatospleno Skintigrafi

7. Arteriografi

RUPTUR GINJAL:


2. Ultrasonografi

3. IVP

4. CT-Scan

5. Renogram

6. Renoskintigrafi

7. Renal arteriografi

Traumatologi

ABDOMEN

RUPTUR USUS / PERFORASI USUS:

1. Foto abdomen 3 posisi

2. Ultrasonografi

3. Skintigrafi gastrointestinal

RUPTUR KANDUNG KEMIH (VU):

1. Foto polos abdomen / BNO

2. Ultrasonografi

3. IVP

4. Urethrokistografi