Dr. Yanto Budiman, Sp.Rad., M.

Kes Bagian Radiologi FK/RS Atma Jaya Jakarta

Pelvis Male

Pelvis Female

Liver Billiary system Gall bladder Pancreas Spleen Stomach Intestine Colon

 Liver.

Horizontally subdivided by the main branches

of the portal vein into cranial and caudal part. The main hepatic vein mark the borders of the segments 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

Hepatic Cysts
Simple hepatic cyst Hydatid cyst

Hepatic metastases Solid hepatic lessions

Hemangioma Adenoma Focal Nodular Hyperplasia

Diffuse hepatic changes

Fatty Liver Hemochromatosis Cirrhosis

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.

Cyst

 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.

Hydatid cyst Liver multiloculated spleen

 Multiple

focal lesions suggest liver metastases Common originate from colon, lung , breast , kidney and uterus enhanced is obtained in venous and early arterial phase.

Venous phase

Early arterial phase

 The

most common benign hepatic lesion. In unenchaned images : well defined homogeneous areas of decreased attenuation After injection CM : enhancement begins in the periphery and progresses toward the centre of hemangioma

 Occurs

in women, age 20-60, long history of taking oral contraceptives. Originate in hepacotcytes. Usually isodense, sometimes hypervascular, and may be accompanied by hipodense infarction, central necrosis, and/or hemorrhage.

 Do

not show any tendency of malignant degeneration. On unenhanced images : appear as hypodense, sometimes isodense, welldefined lesions After i.v CM : an irregularly shaped, hypodense central area

 Pneumobilia Cholestasis

 Gas

in the billiary tract.(fig 124.4)

Common causes: sphincterotomy, ERCP, surgical

choledohoenteric anastomosis. Hypodense gas within intrahepatic bile ducts.

 Cholestasis

(fig 124.5)

Common causes : gallstone, pancreatic

carcinoma Diagnosis been made if the diameter > 5 cm in several transverse planes

cholestasis

 Cholecystolithiasis Chronic

Inflammatory lesions

 Cholecystolithiasis

Has different patterns of calcification Cup shapes calcification : cholesterol Ring calcification : billirubin stone.

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

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)

 Acute

and Chronic Pancreatitis Pancreas Neoplasms

 Acute

pancreatitis :

Blurring of pancreatic contour, lobbular patern of

pancreas is effaced. Hypodense pancreatic fluid and edema of the connective tissue

 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 the regional lymph nodes Islet cell tumors, 75 % of which are functional, located within the body of pancreas.

 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

Inflammation of the intestines

Examined thickening wall : Ulcerative colitis

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

DIC or over-anticoagulation : hemorrhage in the bowel wall and mural thickening (fig 139.6a) dd/ Ischemia, as a result of atheroslerosis od embolus

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