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    MSCT SCAN ABDOMEN PDSRI DR Ira

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    Guntur Saputra
    CT is useful for evaluating appendicitis as it allows direct visualization of the appendix and periappendiceal structures. Key CT findings of appendicitis include thickening of the appendix wall, enhancement of the appendix, periappendiceal fat stranding, and appendicoliths. With perforation, CT may show periappendiceal abscess, retroperitoneal air, fluid collections, or displacement of bowel loops. CT accurately assesses severity and extent of disease.

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    MSCT SCAN ABDOMEN PDSRI DR Ira

    Uploaded by

    Guntur Saputra
    32 views78 pages
    CT is useful for evaluating appendicitis as it allows direct visualization of the appendix and periappendiceal structures. Key CT findings of appendicitis include thickening of the appendix wall, enhancement of the appendix, periappendiceal fat stranding, and appendicoliths. With perforation, CT may show periappendiceal abscess, retroperitoneal air, fluid collections, or displacement of bowel loops. CT accurately assesses severity and extent of disease.

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    CT is useful for evaluating appendicitis as it allows direct visualization of the appendix and periappendiceal structures. Key CT findings of appendicitis include thickening of the appendix wall, enhancement of the appendix, periappendiceal fat stranding, and appendicoliths. With perforation, CT may show periappendiceal abscess, retroperitoneal air, fluid collections, or displacement of bowel loops. CT accurately assesses severity and extent of disease.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    32 views78 pages

    MSCT SCAN ABDOMEN PDSRI DR Ira

    Uploaded by

    Guntur Saputra
    CT is useful for evaluating appendicitis as it allows direct visualization of the appendix and periappendiceal structures. Key CT findings of appendicitis include thickening of the appendix wall, enhancement of the appendix, periappendiceal fat stranding, and appendicoliths. With perforation, CT may show periappendiceal abscess, retroperitoneal air, fluid collections, or displacement of bowel loops. CT accurately assesses severity and extent of disease.

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    of 78

    GA.

    Indirawati
    Jakarta , 13th August 2016
    Why CT ??

     Cross sectional imaging


     Global assessment
     Operator independant
     ( almost ) readily available
     Direct visualization
     Periappendiceal & other structures
     Severity & extention
     Sometimes : Non Enhanced CT is OK
    • Obstruction of appendiceal lumen

    • Distention of appendix
    • Superimposed infection

    • Ischemia
    • Eventually : perforation
    Findings

     Non filling appendix


     Enlargement ( > 6 mm / > 7 mm ) in outer
    diameter
     Thickened , abnormal wall enhancement
     Periappendiceal fat stranding
     Appendicolith : more on CT than plain photo
     Thickened caecum and terminal ileum wall
     Appendicolith ( 25 – 40 % with CT )
     Right lower quadran lymphadenopathy
    With perforation :

     Pericaecal abscess
     Retroperitoneal air
     Fluid collection , in RLQ
     Displacement of bowel loop from RLQ
     Marked ileocaecal thickening
     Peritonitis
     Small bowel obstruction
     Defect of wall enhancement
    • Staging

    • Assessing recurrent disease

    • Detecting distant metastases


    • Follow up
     Accuracy 70-80 %
     Able to asses nodes & metastases
     Small masses

     CT Colonography
    Findings

     Assymetric wall thickening (+/- iregular


    surface)
    Wall thickness normal : < 3 mm
    3-6 mm indeterminate , > 6 mm abnormal
     Annular : thickening bowel wall & lumen
    narrowing
     Focal , intraluminal soft tissue density mass
     Stricture with bowel obstruction
     Length of bowel involvement :
     Enhancement : grey

     Associated feature : invagination ,


    obstruction , fistulae ( ? )
    Extracolonic extension
    o Mass with irregular border
    o Pericolonic fat stranding /streaky bands
    o Loss of soft tissue plane between colon &
    surrounding structures
    o Peritoneal metastase / omental cake
    o Messenteric LN
    STAGING
    Stage A : limited to mucosa +/- submucosa
    ( T1N0M0 )
    Stage B : limited to serosa or adjacent tissues
    ( T2/3N0M0 )
    Stage C : LN metastases ( T2/3N1M0 )
    Stage D : Distant metastases ( any T / M )
    Colon mass
    Colon mass
    Increased use of CT for evaluating
    IBD

    Detection & characterization of the


    lesion
    Findings
     Circumferential diffuse & symmetrical wall
    thickening
     Length of bowel involvement : > 10 cm –
    entire colon
     Fold enlargement, lack of haustral pattern
     Luminal narrowing , accordion sign
     Pericolonic fat stranding / proliferation
     Widening of presacral space
     Lymphadenopathy
     Ascites
     Toxic megacolon maybe present
     Toxic megacolon :

    A syndrome of colonic dilatation,


    abdominal
    pain , fever & leucocytosis.
    Perforation 50 % cases
    High mortality rate !!
    Spectrum
     Crohn’s disease
     Ulcerative colitis
     Pseudomembranous colitis
     Thyphlitis
     Radiation
    etc
     Target signs
    1. Enhancing inner ring of bowel wall
    ( mucosa )
    2. Non enhancing middle ring
    ( submucosa )
    3. Enhancing outer ring bowel wall
    ( muscularis propia )
    Findings
     Small outpouchings of colonic wall
     Contains air, contrast or fecal material
    Diverticulitis
     Focal bowel wall thickening
     Pericolonic fat stranding
     Possibly gas / fluid collection adjacent to the
    wall ( abscess ) , sinus tract , fistulae etc
     Sigmoid ( 65% -70 % ) , descending colon ( 25
    % - 30 % )
     Location : antimesenteric side
    • Caused by many conditions
    • Variable clinical presentation

    • CT findings sometime non specific


    • Involving small or large bowel

    • Best : Clinico - radiological diagnosis


     Causes
    Hypovolemic shock
    Congestive heart failure
    Closed loop obstruction /mechanical
    Thrombosis / occlusion of SMA / SMV
    Inflammation
    Others
    Findings

     Segmental symmetric thickening of bowel


    wall
     Luminal narrowing or dilatation with air –
    fluid levels
     Small bowel feces sign
     Variety of mucosal enhancement
     Loss of haustra
    Findings
     Messenteric fat infiltrated by edema
    ( “ misty messentery “ )
     Intramural gas
     Vascular engorgement
     Free fluid
     Portal venous gas
    Inflammation
    Inflammation
     Bowel within bowel.
    Proximal segment ( intussusceptum ) into
    lumen of distal segment ( intussuscipiens )

     Ileo-ileal,ileo-colic, colocolic
     Short segment : non obstructing ,idiopathic
     Long segment : obstructing , mass
    CT Findings
    1. Early stage : “ Target Sign “
    Outer layer = intussuscipiens
    Inner layer = intussusceptum
    2. As it progress : “ Sausage – shaped mass “
    Layering pattern of low density ( mesenteric
    & fat ) and high density ( bowel wall )
    3. Reniform / kidney like mass
    Due to wall edema / thickening

    4. Features / sign of bowel obstruuction


    3 . Kidney shaped / reniform
    Due to mural thickening

    4. Signs of bowel obstruction


    Direct CT findings

     Discontinuity of the bowel wall


     Extraluminal air
    Indirect CT findings
     Bowel wall thickening
     Abnormal wall enhancement
     Abscess
     Inflammatoy mass adjacent bowel
    Stomach duodenum perforation
    o Abundant
    o Around liver & stomach

    Post bulbar duodenum perforation


    o Right anterior pararenal space
    Small bowel perforation

    o Small
    o Messenteric fold
    o Around liver
    Large bowel perforation

    o Variable
    o Pelvic
    o Messenteric fold
    o Retrperitoneal space
    Appendix perforation
    o Around appendix

    Use : “ Wide window setting “


    Synonyms
    Peritoneal carcinomatosis
    Peritoneal implant
    Omental cake
    Findings
     Nodular enhancement of peritoneum
     Hypovascular omental caking
     Ascites

    DD : TB peritonitis
    1. Diferentiating between extraluminal &
    intramural gas
    2. Detection of lymphnode
    3. Notice omental cake
    4. Vascular abnormalities
    5. Check adrenal / suprarenal gland

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