TRAUMA ABDOMEN

Dr.JB.Prasodjo,dr.Sp.Rad. (K)
April 2011

Gambaran makro

VERTEBRAE NORMAL
FOTO

: - AP
- LATERAL
- OBLIQUE ( BILA PERLU )
YANG DIPERHATIKAN :
Discus
Foramen
Pedicle
Corpus Vertebrae
Soft tissue

Perkembangan lengkung vertebra

Diagram foto lumbal lateral

Diagram foto Lumbosacral (LS) lateral

Diagram foto LS oblik

LS joint

Stabilitas LS joint

Analisis LS joint lishtesis

A. Fleksi
B. Ekstensi

FOTO : 2 POSISI SATU DGN LAIN

PD FRAKTUR PERHATIKAN :
- UMUR
- LOKASI FRAKTUR
- POSISI FRAGMEN
UTK LOKASI TL DIBAGI :
- 1/3 PROX
- 1/3 MED
- 1/3 DIS

FRAKTUR TL. PUNGGUNG

LOKASI
FOTO
RAD

: - TORAKAL BAG. BAWAH + LUMBAL

:
AP + LAT
: - VERT. BENTUK BAJI / KAPAK
- DISK MASIH BAIK

Fraktur vertebra lumbal

CT Lumbal 2

Structure "A"
Structure "B"
Structure "C"
Structure "D"

CT Lumbal 3

Structure "A"
Structure "B"
Structure "C"
Structure "D"

Laserasi Hepar

A. Liver
B. Fluid in the peritoneal cavity
C. Left kidney (salah)
D. Falciform ligament
E. Splenic flexure

Laserasi Hepar
The items seen on the
CT at liver are the liver
laceration with hematoma
(#1), gallbladder (#2),
nasogastric tube (#3),
inferior vena cava (#4),
aorta (#5), tail of the
pancreas (#6), and spleen
(#7).

 Diagnosis: Liver laceration, severe

The most frequent site of liver injury is the posterior
segment of the right lobe because of its large
volume and its proximity to ribs and vertebrae. The
dual blood supply of the liver and the inability of
liver veins to contract means that hemorrhage from
a liver injury may be very significant. However, if
the liver capsule remains intact, the injuries are
less serious. Fortunately the liver heals rapidly and
delayed rupture rarely occurs.

Laserasi Lien

A. Spleen
B. Splenic laceration
C. Gallstones
D. Liver
E. Pancreas

 Diagnosis: Splenic laceration

In a patient with major trauma, three examinations
are indicated.
1. Lateral C-spine to rule out cervical spine injuries.
2. Chest x-ray to rule out injury to the heart, great
vessels, lungs, and mediastinum and to assess
integrity of the diaphragm.
3. Contrast-enhanced CT of the abdomen (if the
patient is hemodynamically stable) to diagnose and
evaluate injury to the spleen, liver, kidneys,
pancreas, retroperitoneum, and pelvis.

Laserasi Ginjal

A. Inferior vena cava

B. Right kidney
C. Left kidney
D. Head of pancreas
E. Liver

 A contrast-enhanced CT was obtained which

demonstrates a large focal area of lack of perfusion
(arrowheads) in the left renal parenchyma. This
represents renal laceration with hematoma. There is
also a small perirenal hematoma. Other structures
are:
A=aorta
B=right kidney
C=left kidney
D=head of pancreas
E=liver
Diagnosis: Renal laceration with hematoma

Laserasi Ginjal

1=liver
2=gallbladder
3=stomach
4=bowel
5=liver laceration
6=right kidney
7=left kidney
8=aorta

Laserasi Ginjal

1=bowel
2=inferior vena cava
3=aorta
4=retroperitoneal hemorrhage
5=acute bleeding into left kidney
6=inferior tip of right kidney

Laserasi Ginjal

1=bowel
2=right ureter
3=right psoas
4=retroperitoneal
hemorrhage
5=right sacral fracture
6=diasthesis left S-I joint

 There is no perfusion of the left kidney on CT1

and CT2. This is best explained by a tear of
the left renal artery causing lack of perfusion
of the left kidney. On CT2 the high attenuation
represents acute bleeding. A hematoma in the
retroperitenum is seen on CT2 and CT3.
Diagnosis: Avulsion of renal artery
At surgery, a tear of the left renal artery was
found with a large retroperitoneal hematoma.
The patient required a left nephrectomy.

Ruptura VU
A. Air in the urinary bladder
B. Left ureter (salah)
C. Contrast in the urinary
bladder
D. Contrast outside of the
urinary
bladder
E. Contrast in the peritoneal
cavity

Ruptura VU

 Two CT images are shown (CT above

acetabulum and CT at sacrum).
A=air in urinary bladder
B=right ureter
C=contrast in urinary bladder
D=contrast outside urinary bladder
E=contrast in peritoneal cavity
This patient had an intraperitoneal bladder
rupture and underwent urgent surgical
repair.
Diagnosis: Bladder rupture