Foto Polos

Abdomen
• M. Rizki Firmansyah

• Ratih Mega A

• Stephen Tohodo O
Indikator pembacaan Foto Polos Abdomen
 Gas in
stomach
Normal foto
abdomen
Gas in a few
loops of
small bowel

Gas in
rectum or
sigmoid

Normal Gas Pattern

 Always
air/fluid level
in stomach

A few
air/fluid
levels in
small bowel

Erect Abdomen
4
 Large vs. Small Bowel

l Large Bowel
n Peripheral
n Haustral markings don't
extend from wall to wall
l Small Bowel
n Central
n Valvulae extend across lumen
n Maximum diameter of 2"

6
Pneumoperitoneum
1-3) RUQ/Liver signs on supine AXR: 9) Double Bubble Sign
• Anterior Subhepatic Space FreeAir
• Doges Cap Sign 10) Cupola Sign
• Air Anterior to Ventral Surface of Liver
11) Lesser SacGas
4) Rigler’s Sign
12) Triangle Sign
5) Decubitus Abdomen Sign
13) Abscess Gas
6) Falciform LigamentSign

7) Football Sign 14) Pneumoretroperitoneum

8) Continuous DiaphragmSign 15) Others

• Supine; RUQ/Liver sign 1
• Linear shape

Index
 • Supine; RUQ/Liver sign 2
shaped latera

corner
border outlini
medial border of the liver
4. Positioned inferior to
the 11thrib
5. Positioned superior to the rig
kidney

Morrison’s pouch =
a potential space between the right kidney &
the liver

Index
• Supine; RUQ/ Liver sign 3
• Uneven density in

Index
• Supine
• Bowel wall

(extraluminal = free
peritoneal gas)
of bowel wall
can be seen
(red arrows)

Index
Rigler Sign / Double wall sign

– Adanya bayangan
udara di luar
sistema usus
sehingga dinding
usus tampak
sangat prominent
• Left lateral
decubitus
• Air-fluid level

between
the abdominal
wall and the liver

in the
peritoneum

Index
Decubitus Abdomen Sign
• Supine
• Falciform ligament
– connects the anterior
abdominal wall to the
liver
– extends inferiorly
beyond the liver →
becomes round ligament
– becomes
in a patient with free
abdominal gas

Index
Falciform ligament sign
• massively air-filled
peritoneum

Index
• massive
pneumoperitoneum
→ sufficient air
beneath the
diaphragm
• left & right
hemidiaphragms
contrasted by the
free gas appear as a

Index
• subdiaphragmatic gas
under the left
hemidiaphragm

– subdiaphragmatic free
gas (under black arrow)
– normal gas within the
fundus of the stomach
(under white arrow)

Index
• Air accumulation
beneath the central
tendon of the
diaphragm

Index
• The lesser sac
– positioned posterior to
the stomach
– usually a potential space

Note:
White arrow = Cupolasign

Index
• small triangles of free
gas positioned between
the large bowel and the
flank

Index
• arrowed
NOT clearly contained
within normal hollow
abdominal viscus
– NOTaligned in a linear
fashion nor outline
normal haustral features

Index
• Air seen surrounding
the lateral border of the
kidney (retroperitoneal
organs)
• If the gas is seen to
move in an erect and
decubitus view, it's
in the retroperitoneum

Index
 Inverted V
Urachus Sign
Sign

Leaping Ligamentum
Dolphins Sign Teres Sign

Index
• Air contrasted urachus
• Vertical line between
bladder and umbilicus
• Outline of medial
umbilical ligament

Index
 • Supine
• Free air outlining the

, coursing
inferiorly and laterally
from the umbilicus
– Infants: umbilical
arteries
– Adults: inferior epigastric
vessels

http://dx.doi.org/10.1148/radiology.151.1.6230689
Index
• Air under
hemidiaphragm and
diaphragmatic muscle
slips visible

Index
 • Extraluminal air in the
fissure for the
Ligamentum Teres
• Linear density running
along the inferior edgeof
the falciform ligament

Picture: DOI: 10.1056/NEJMicm0904627 Emerg Med J2011;28:728

doi:10.1136/emj.2010.098699
Index
ILEUS OBSTRUKTIF
Small Bowel Obstruction
 ILEUS
OBSTRUKSI
LETAK
TINGGI
Ileus Obstruktif
– Jenis Foto : tegak
– Deskripsi :
– Jumlah udara meningkat
– Distribusi udara tidak normal
– Terdapat gambaran multiple air
fluid level
Ileus Obstruktif
– Jenis Foto : Tegak
– Deskripsi :
– Jumlah udara meningkat
– Distribusi udara tidak normal
– Terdapat gambaran air fluid
level yang membentuk step
ladder pattern
 Ileus Obstruktif letak tinggi
– Jenis Foto : Supine & LLD
– Deskripsi :
– Jumlah udara meningkat
– Distribusi udara tidak normal
– Terdapat gambaran coil spring
yang membentuk herring
bone appearance
– Terdapat gambaran air fluid
level yang membentuk step
ladder pattern
Large Bowel Obstruction
SUPINE ERECT
ILEUS PARALITIK
– Jenis Foto : Supine
– Deskripsi :
– Jumlah udara meningkat
– Distribusi udara tidak normal
– Terdapat gambaran coiled spring
yang membentuk herring bone
appearance
– Jenis Foto : LLD
– Deskripsi :
– Jumlah udara meningkat
– Distribusi udara tidak normal
– Terdapat gambaran air fluid level yang membentuk
line up
TERIMAKASIH