Professional Documents
Culture Documents
Sagital view
hcc
Hipertensi Portal
• Sekunder terhadap sirosis / adanya massa
• Dilatasi v. porta > 13 mm hipertensi portal
v. porta
Teknik scanning
Penilaian Vesika Felea
• Ukuran
• Dinding menebal atau tidak
• Batu
• Massa
1. Gallstone
Kolesterol / kalsium
echogenic band dg acoustic shadow
dipastikan dengan perubahan posisi pasien
dislodge ~ polip
2. Kolesistitis
• Inflamasi di vesika felea, biasanya k/ batu
• Awal hanya nyeri tekan
late edema ~ dinding menebal dan multipel
layer
• Dinding V F > 4 mm
• Perikolesistik fluid
Anatomy
• Kidneys are retroperitoneal, T12 - L4
• Right kidney is lower than the left kidney
• Right kidney is posterio-inferior to liver &
gallbladder
• Left kidney is inferior-medial to the spleen
• Adrenal glands are superior, anterior, medial to
each kidney
Hepatic
Veins
Spleen
Celiac
axis
Liver
SMA Left
Right
Renal artery kidney
kidney
Renal vein
Approach to Scanning
LIVER STOMACH
I
K K
AORTA
IVC
S
• Right kidney scanning • Left kidney: requires a
approach: anterior, posterior approach, through
lateral, posterior
the spleen
• Liver is the acoustic
window • Air-filled bowel impedes
anterior scanning
Anatomy
• 9-12 cm long, 4-5 cm wide, 3-4 cm thick
• Gerota’s fascia encloses kidney, capsule, perinephric
fat
• Sinus
▫ Hilum: vessels, nerves, lymphatics, ureter
▫ Pelvis: major and minor calyces
• Parenchyma surrounds the sinus
▫ Cortex: site of urine formation, contains nephrons
▫ Medulla: contains pyramids that pass urine to minor
calyces. Columns of Bertin separate pyramids
Medullary pyramids
Kidney
Minor
Calyx Anatomy
Major
Calyx
Sinus
Medulla
Renal capsule
Cortex
Sonographic Appearance
• Ureters are normally not seen
• Renal pelvis is black when visible
• Renal sinus is echogenic due to fat
• Medullary pyramids are hypoechoic
• Cortex is mid-gray, less echogenic than liver or
spleen.
• Capsule is smooth and echogenic
Right Kidney Long Axis
Anterior
Superior Inferior
Liver
Sinus
Cortex
Diaphragm
Posterior
Right Kidney Short Axis
Anterior
Right Left
GB Liver
IVC
R Kidney
Vertebral
Aorta
Body Renal a.
Posterior
Left Kidney Long Axis
Anterior
Superior Inferior
Rib
Shadow
Kidney
Posterior
Spleen
Left Kidney Short Axis
Anterior
Spleen
L Kidney
Posterior
Common Pitfalls in
Renal Scanning
• Failure to scan both kidneys
• Mistaking prominent renal pyramids
for hydronephrosis
• Mistaking prominent pyramids for
cysts
• Confusing normal renal arteries for the
ureter
Common Pitfalls in
Renal Scanning
• Failure to scan through the bladder to
search for stone at the uretero-vesicular
junction
• Inability to visualize left kidney due to
anterior probe placement
• Failure to scan the aorta in suspected
renal colic
Normal Variants
• Dromedary humps:
▫ Lateral kidney bulge, same echogenicity as the cortex
• Hypertrophied column of Bertin:
▫ Cortical tissue indents the renal sinus
• Double collecting system:
▫ Sinus divided by a hypertrophied column of Bertin
• Horseshoe kidney:
▫ Kidneys are connected, usually at the lower pole
• Renal ectopia:
▫ One or both kidneys outside the normal renal fossa
Clinical Indications
1. Obstructive Uropathy
Nephrolithiasis
•Severe
▫ Marked dilation of the renal pelvis and thinning of
the renal parenchyma
Range of Hydronephrosis
GB
Kidney Liver
Moderate - Severe
Hydronephrosis
GB
Kidney
Liver Dilated pelvis
Renal Pathology
1. Renal Cysts
Renal Cysts
• Arise in the renal cortex, commonly single rather
than multiple
• Cysts do not communicate; hydronephrosis does
• Shape is round or oval
• Echo free
• Sharp interface between the mass and renal tissue
• Large renal cysts may be mistaken for aortic
aneurysms
Renal Cysts
Penilaian Pankreas
• Ukuran
• Ekogenisitas parenkim
• Kalsifikasi
• massa
• Ekogenisitas parenkim >> dg bertambahnya usia
• Ukuran normal
kaput : < 3 mm
korpus : < 2,5 mm
kauda : < 2,5 mm
PANKREATITIS
• Penyebab
billiary pankreatitis ; batu di CBD
alkoholisme
• Pankreatitis akut
ukuran membesar ( thickness )
hipoekogenisitas parenkim
• Pankreatitis kronis
heterogenous fibrosis
kalsifikasi
tepi yang irreguler
• Posisi RLD dengan pasien melakukan inspirasi dalam
• Posisi transduser sejajar dengan ICS
• Tervisualisasi dome diafragma dan hilus lien
• Normal ukuran lien < 11 cm
1. Diffuse Splenomegali
• Hipertensi portal, infeksi, proses p>> sintesis
eritrosit ( anemia hemolitik, polisitemia )
• Sistemik hematologi diseases leukemia
• Splenomegali dimulai dengan rounding dr
bentuk crescentnya giant spleen kissing
phenomenon
2. Focal Change
b
a
Vol = A x B x C x 0,52
c
Penilaian Vesika Urinaria
• Dinding
• Permukaan
• Batu
• massa
• Dinding dan lumen V U hanya dapat dievaluasi bila V U
dalam keadaan penuh
Pada pasien dengan kateter Foley maka diklem ter
lebih dahulu
• V U yang penuh window uterus / prostat
• Dinding V U tidak boleh melebihi 4 mm jika lebih dari
4 mm didiagnosa dg sistitis
• Vesikolitiasis
• Massa TCC
PENILAIAN PROSTAT