Bangun Nusantoro, dr.

Sp,Rad

PANCA INDERA
5 Lima Alat Indera Manusia :
Mata, Hidung, Telinga, Lidah & Kulit (Panca Indera) 1. Indera Penglihatan / Penglihat = Mata 2. Indera Penciuman / Pencium = Hidung 3. Indera Pengecap = Lidah 4. Indera Pendengaran / Pendengar = Telinga / Kuping 5. Indera Peraba = Kulit

PANCA INDERA

PANCA INDERA

ORBITA

MATA

HIDUNG

TELINGA

Indera Pengecap = Lidah

Indera Peraba = Kulit

Tingkatkan Pancaindra Kita

PEMERIKSAAN IMAGING PANCAINDRA

1. RO :RADIOGRAPHY 2. CT SCAN 3. USG 4. MRI 5. RADIO ISOTOP SCANNING

TRAUMA PADA INDRA PENGELIHATAN

Unenhanced axial CT scan of a healthy 32year-old man. AC = anterior chamber, L = lens, ON = optic nerve, PS = posterior segment (vitreous humor).

Photograph shows posttraumatic hyphema in a 25-year-old man.

Corneal laceration in a 22-year-old man. Unenhanced axial CT scan shows decreased volume of the anterior chamber, a finding that confirms the diagnosis

TRAUMA PADA INDRA PENGELIHATAN

Unenhanced axial CT scan of a 29-yearold man shows complete subluxation of the lens.

Unenhanced axial CT scan of a 49-yearold woman shows a partially dislocated lens.

Ruptured globe in a 43-year-old man. Unenhanced axial CT scan shows the flat tire sign, which indicates an open-globe injury.

KELAINAN INDRA PENGELIHATAN

Ruptured globe in a 35-year-old man. Unenhanced axial CT scan shows extrusion of the lens Congenital coloboma in a 53-year-old man who presented with decreased visual acuity. Unenhanced axial CT scan shows a deformity at the left optic nerve head.

Mimic of open-globe injury in an 82-yearold man who presented with head trauma. Unenhanced axial CT scan shows metal adjacent to the globe, a finding that is a mimic for a penetrating injury. In this case, it is the metal buckle of a previously placed

TRAUMA PADA INDRA PENGELIHATAN

Mimics of open-globe injury in a 28-yearold man who presented with a penetrating injury to the globe. (a) Unenhanced axial CT scan shows a 45-mm metallic foreign body inside the globe. (b) Unenhanced axial CT scan shows small dependent areas of attenuation, possibly vitreous
Retinal hemorrhage in a boy less than 1 year old who presented with trauma. (a) Unenhanced axial CT scan obtained at a caudal level shows bilateral retinal hemorrhage. (b) Unenhanced axial CT scan obtained at a cranial level shows traumatic brain injuries that include subdural hematomas, intraventricular blood, and subarachnoid hemorrhage. (c, d) Axial T2-weighted MR images (2500/100 [repetition time msec/echo time msec]) obtained at a cranial (c) and caudal (d) level show the hemorrhages more clearly. Note the fluid-fluid level in d.

Figure 1a.

TRAUMA PADA INDRA PENGELIHATAN

Retinal hemorrhage in a boy less than 1 year old who presented with trauma. (a) Unenhanced axial CT scan obtained at a caudal level shows bilateral retinal hemorrhage. (b) Unenhanced axial CT scan obtained at a cranial level shows traumatic brain injuries that include subdural hematomas, intraventricular blood, and subarachnoid hemorrhage. (c, d) Axial T2-weighted MR images (2500/100 [repetition time msec/echo time msec]) obtained at a cranial (c) and caudal (d) level show the hemorrhages more clearly. Note the fluid-fluid level in d.

Figure 1b.

Figure 1 c.

Retinal hemorrhage in a boy less than 1 year old who presented with trauma. (a) Unenhanced axial CT scan obtained at a caudal level shows bilateral retinal hemorrhage. (b) Unenhanced axial CT scan obtained at a cranial level shows traumatic brain injuries that include subdural hematomas, intraventricular blood, and subarachnoid hemorrhage. (c, d) Axial T2-weighted MR images (2500/100 [repetition time msec/echo time msec]) obtained at a cranial (c) and caudal (d) level show the hemorrhages more clearly. Note the fluid-fluid level in d.

TRAUMA PADA INDRA PENGELIHATAN

Figure 1
Retinal hemorrhage in a boy less than 1 year old who presented with trauma. (a) Unenhanced axial CT scan obtained at a caudal level shows bilateral retinal d.hemorrhage. (b) Unenhanced axial CT scan obtained at a cranial level shows traumatic brain injuries that include subdural hematomas, intraventricular blood, and subarachnoid hemorrhage. (c, d) Axial T2-weighted MR images (2500/100 [repetition time msec/echo time msec]) obtained at a cranial (c) and caudal (d) level show the hemorrhages more clearly. Note the fluid-fluid level in d. Unenhanced axial (a) and coronal (b) CT images of a 40-year-old woman show a right serous choroidal detachment secondary to ocular hypotony.

Figure 2 a.

Figure 2b.

Unenhanced axial (a) and coronal (b) CT images of a 40-year-old woman show a right serous choroidal detachment secondary to ocular hypotony.

Indera Penciuman / Pencium = Hidung

CT Scans
Sangat menolong untuk melihat fraktur dan

juga dapat menyingkirkan dari lesi di basis cranii aterior

Inspeksi Indera Penciuman / Pencium = Hidung

Imaging Indera Penciuman / Pencium = Hidung

Imaging Indera Penciuman / Pencium = Hidung

Diagnosis Kelainan Indera Penciuman / Pencium = Hidung

Rhinoscopy Endoscopy Imaging studies

Rhinoscopy Endoscopy Imaging studies

Imaging Kelainan Indera Penciuman / Pencium = Hidung

Pembengkakan didaerah pipi dengan displacement isi orbita

Imaging Kelainan Indera Penciuman / Pencium = Hidung

Proptosis, gerakan bola mata yang terbatas, dan diplopia mungkin bisa terjadi, tergantung dari lokasi massa.

Symptome
Pasien secara klinis pembengkakan yang lunak dan eritema di dahi

Intra kranial komplikasi osteitis atau osteomyelitis

Epidural, subdural and intracerebral abscesses Meningitis
Sinus Thrombosis and Thrombophlebitis

Orbital Neoplasma

Axial CT scan revealing lateral orbital neoplasm.

Orbital Neoplasma

Embryonal rhabdomyosarcoma with alveolar features in an 18-year-old boy with left proptosis.

Local Spread and Metastasis

Figure a. Rhabdomyosarcoma involving the orbit and maxillary sinus in an 18-yearold girl with erythema of the right lower eyelid followed by proptosis 2 months later.

Figure b. Rhabdomyosarcoma involving the orbit and maxillary sinus in an 18-yearold girl with erythema of the right lower eyelid followed by proptosis 2 months later

Venous-lymphatic malformation
Figure @ . Venous-lymphatic malformation in a 9-year-old girl. (a) Axial unenhanced CT image reveals a medial soft-tissue attenuation mass with calcification (arrowhead).

Figure (a). Venous-lymphatic malformation of the orbit and face with associated sinus pericranii and developmental venous anomaly.

Venous-lymphatic malformation
Figure (b,c,d) Venous-lymphatic malformation of the orbit and face with associated sinus pericranii and developmental venous anomaly. (a) Axial contrastenhanced CT image shows a lobular intraconal mass on the left, which enhances as much as muscle. (b) Coronal contrast-enhanced CT image shows that some portions of the multilobular mass have enhancement features similar to those of muscle (arrowheads) and that another portion is less enhancing (arrow). (c) Coronal CT image shows abnormal veins along the walls of the lateral ventricles (arrowhead). (d) Coronal CT image (bone window) shows multiple bony defects of sinus pericranii in the left frontal bone (arrowhead) that allow anomalous venous drainage from the face to the intracranial venous structures.

Local Spread and Metastasis

Figure a. Rhabdomyosarcoma in a 4year-old boy with sickle cell anemia.

Figure b. Rhabdomyosarcoma in a 4year-old boy with sickle cell anemia

Figure c. Rhabdomyosarcoma in a 4year-old boy with sickle cell anemia.

Local Spread and Metastasis

Figure a. Embryonal rhabdomyosarcoma in a 4-year-old girl with right proptosis. (a) Axial T1-weighted MR image demonstrates a well-defined mass that is iso- to slightly hypointense relative to muscle (arrowhead). Note the swelling of the upper eyelid.

Figure b. Axial T1-weighted image with fat saturation shows intense, rimlike enhancement (arrowhead) of the mass and overlying lid.

Local Spread and Metastasis

Figure a. Rhabdomyosarcoma with imaging features mimicking those of hemangioma in a 4year-old boy with right eye pain and proptosis

Figure b. Rhabdomyosarcoma with imaging features mimicking those of hemangioma in a 4-year-old boy with right eye pain and proptosis.

Local Spread and Metastasis

Figure c. Rhabdomyosarcoma with imaging features mimicking those of hemangioma in a 4year-old boy with right eye pain and proptosis.

Figure d. Rhabdomyosarcoma with imaging features mimicking those of hemangioma in a 4year-old boy with right eye pain and proptosis.

Infeksi pada mata

Figure (a). Orbital cellulitis in a 5-year-old boy with periorbital erythema. (a) Axial CT image shows increased attenuation in the preseptal and postseptal fat, a finding consistent with inflammation. Note the softtissue opacification of the ethmoid air cells and sphenoid sinus

Figure (b) Coronal contrast-enhanced CT image shows a subperiosteal abscess (arrowhead) along the lamina papyracea. The rim enhancement seen here is rare in rhabdomyosarcoma.

Tumor Jinak pada Anak

Figure (a). Infantile hemangioma in a 2month-old infant who was noted to have a mass in the left temporal area shortly after birth. (a) Coronal T2-weighted image shows a mass slightly hyperintense relative to muscle and brain that contains numerous black flow voids (arrowheads)

Figure (b) Axial T2-weighted image shows that the mass extends into the temporal region. Note the prominent intratumoral flow voids (arrowhead).

Tumor Jinak pada Anak

Figure (a). (b) Capillary hemangioma i n an 8week-old girl with a 2-week history of left proptosis. (a, b) Axial contrast-enhanced CT images (a obtained at a lower level than b) show an intensely enhancing intraconal mass in the left orbit

Tumor Jinak pada Anak

Figure (a). Capillary hemangioma in a 9week-old girl with right exophthalmos. (a) Axial T1-weighted image shows the lobular contour of an intraconal mass (arrowhead) with signal intensity similar to that of muscle and contrasted against the hyperintense conal fat. (b) Axial contrastenhanced T1-weighted image with fat saturation demonstrates diffuse intense enhancement of the lobular mass. (c) Sagittal T2-weighted image also shows the hyperintense mass, which contains flow voids (arrowhead).

Indera Pengecap = Lidah

Indera Pengecap = Lidah

Figures 3 - 5 (3) Coronal MR image (a) and corresponding

cadaveric specimen (b) demonstrate the normal anatomy of the oral cavity. Position of the MR section is indicated by better C on Figure la. (4) Coronal MR image (a) and corresponding cadaveric specimen (b) demonstrate the normal anatomy of the oral cavity. Position of the MR section is indicated by letter D on Figure la. (5) Coronal MR image demonstrates the normal anatomy of the oral cavity. Position of the section is indicated by letter E on Figure 1 a. Refer to Figure 1 for an exphanation of the keys in Figures 3-5.

Indera Pengecap = Lidah

Indera Pengecap = Lidah

Figures 6-8. (6) Axial MR image (a) and corresponding

cadaveric specimen (b) demonstrate the normal anatomy of the oral cavity. Position of the MR section is indicated by letter F on Figure la. (7) Axial MR image (a) and corresponding cadaveric specimen (b) demonstrate the normal anatomy of the oral cavity. Position of the MR section is indicated by letter G on Figure Ia. (8) Axial MR image demonstrates the normal anatomy of the oral cavity. Position of the section is indicated by better H on Figure la. Refer to Figure 1 for an explanation of the keys in Figures 6-8.

Indera Pengecap = Lidah

Figure 9. Exophytic lesion of the tongue. Axial Tiweighted (a) and coronal proton-density-weighted (b) images demonstrate a tumor (arrowheads) that, without the clinical findings, could have been described as arising from the floor of the mouth. Note the mass effect on the buccinator muscle (arrows).

Indera Pengecap = Lidah

Figure 10 Squamous cell carcinoma of the anterior floor of the mouth. (a) Sagittal Ti-weighted image demonstrates a low-signal-intensity tumor (arrowheads). The right submandibular duct (Wharton duct) is dilated (arrow) because its orifIce is obstructed by the tumor. (b) Axial T2weighted image demonstrates the dilated right submandibular duct (straight solid arrow), mybohyoid muscles (open arrows), and hyoglossus muscles (curved arrows).

Indera Pengecap = Lidah

Indera Pengecap = Lidah

Figure 11. Squamous cell carcinoma of the anterior floor of

the mouth with mandibular cxtension. (a, b) Ti-weighted (a) and T2-weighted (b) images demonstrate a tumor that cxtends anteriorly to the oral vestibule (straight solid arrow) and posteriorly to the anterior oral tongue (curved arrow). The mandible is invaded (open arrow). (c, d) Photographs of histologic specimens show the invasion of the medullary bone (arrow in C) and extension along the geniogbossus muscle (arrowheads in d). Ant. = anterior, I = anterior floor of the mouth, 2 = ventral aspect of the tongue, 3 = apex of the tongue, 4 = dorsal aspect of the tongue.

Indera Pengecap = Lidah

Figure 12 Squamous cell carcinoma of the floor of the mouth with extension to the submandibular space. (a) Coronal contrast-enhanced CT scan shows a tumor that enhances only slightly ( ) Th.e amybohyoid muscle is not recognized. (b) Coronal T2weighted image demonstrates disruption of the left mybohyoid muscle and the tumor () which extends into the submandibular space. Medially, it is difficult to differentiate the tumor from the sublingual glands (arrow). Arrowheads = normal right mybohyoid muscle.

Indera Pengecap = Lidah

Figure 13 Tumor of the lateral floor of the mouth with extension to the masticator space. Axial (a) and coronab (b) Ti-weighted images demonstrate a tumor (straight solid arrow) that has invaded the mandible (arrowhead) and the masseter (curved arrow) and medial pterygoid (open arrow) muscles. Note a submandibular lymph node (*).

Indera Pendengaran = Telinga / Kuping

Imaging of the ears

Transverse multi-detector row CT scan of a normal left temporal bone. Tympanic membrane (1) runs laterally to the chorda tympani (2). Anterior (3) and posterior (4) crura of the stapes are shown. Canal of the accessory nerve of the posterior ampullary nerve (5) emerges from the posterior wall of the internal auditory canal laterally and leads to the canal of the posterior ampullary nerve (6). Within a distance of approximately 7 mm, both canals merge to one canal (7) leading directly to the posterior ampulla.

Transverse multi-detector row CT scan of a normal left temporal bone. A normal incudomallear articulation (1) is shown. Canal of the lateral ampullary nerve (2) runs from the canal of the superior division of the vestibular nerve (3) to the lateral ampulla (4).

Imaging of the ears

Coronal images reformatted from transverse multi-detector row CT images of a normal left temporal bone. Incudostapedial articulation (1) is shown. Tegmen tympani (2) can be delineated.
Coronal images reformatted from transverse multi-detector row CT images of a left temporal bone with dehiscence of the facial nerve canal. Tympanic membrane (1) is located between the tympanic cavity and the external auditory canal. Superior malleal ligament (2) runs from the malleleus head to the tegmen tympani. Oval window (3) is located cranially to the round window (4). A lack of complete cortical canal (dehiscence) of the S2 segment of the facial nerve canal (5) is detected near the oval window.

Imaging of the ears

Transverse multi-detector row CT scan of a normal left temporal bone. The anterior malleal ligament (1) and the posterior incudal ligament (2) are shown, as well as the tensor tympani muscle (3), the S2 segment of the facial nerve (4), and the cochleariform process (5).

Transverse multi-detector row CT scan of a normal right temporal bone. Tympanic membrane (1) shows a funnel-shaped appearance. Osseous spiral lamina of the cochlea (2) runs within the cochlea as a hyperdense structure.

Kelainan Telinga bgn Dalam

Coronal high-resolution computed tomography scan shows a cholesteatoma in the posterior epitympanum (blue arrow), erosion of the scutum (white arrow), and rectification of the cochlea (red arrow).

Temporal bone, acquired cholesteatoma. Keratosis obturans. Coronal highresolution CT scan shows destruction of the external auditory canal, lateral to the tympanic membrane (blue arrows), and accumulation of epithelium in the canal (red arrow).

Kelainan Telinga bgn Dalam

Temporal bone, acquired cholesteatoma. Coronal T1-weighted MRI shows evident integrity of the dura without herniation of brain tissue. Gadolinium enhancement of the mastoid is seen; this corresponds with fibrosis seen at surgery.

Temporal bone, acquired cholesteatoma. T1-weighted axial MRI shows a soft-tissue mass in the region of the right tegmen tympani.

Kelainan Telinga bgn Dalam

Glomus tympanicum tumors. (a) Transverse thin-section CT scan (bone algorithm) shows a mass (white arrow) on the promontory, the bone over the basal turn of the cochlea (black arrow). (Reprinted from reference 24.) (b) Transverse T1-weighted gadolinium-enhanced MR image (500/25 [repetition time msec/echo time msec], one signal acquired) shows an intensely enhancing glomus tympanicum tumor (curved arrow) filling the middle ear. The promontory is a convex signal void (straight arrow), but other landmarks are more easily seen on the CT scan in a.

Kelainan Telinga bgn Dalam

Glomus jugulare tumors (and mimic). (a) Transverse thin-section CT scan (bone algorithm) shows erosion of the anterior and lateral cortex (open arrow) of the jugular fossa. The tumor (solid white arrow) extends into the middle ear, making this a glomus jugulotympanicum. The inferior tympanic canaliculus is markedly enlarged (arrowhead), which is indirect evidence of hypertrophy of the inferior tympanic artery, which supplies the tumor. (Reprinted from reference 24.) (b) Transverse T1-weighted MR image (500/11, one signal acquired) of a glomus jugulare tumor shows the intensely enhancing tumor (arrow) in the right jugular fossa. Punctate signal voids of tumor vessels create the salt and pepper pattern. (c) Transverse T2-weighted MR image (3,000/90, two signals acquired) in a patient with no complaints of pulsatile tinnitus shows high signal intensity in the left jugular fossa (curved arrow) and sigmoid sinus (straight arrows). No cause for this slow flow was found.

Kelainan Telinga bgn Dalam

Ossifying hemangioma of the facial nerve. (a) Transverse T1-weighted MR image (566/25, one signal acquired) shows the enhancing mass (arrow) in the right geniculate fossa. (b) Transverse CT scan (bone algorithm) shows enlargement of the geniculate fossa (arrow). Stippled bone, characteristic of an ossifying hemangioma, is seen best at the anterior aspect of the tumor.

Kelainan Telinga bgn Dalam

Posterior fossa dural AVMs. (a) Transverse T1-weighted MR image (520/20, one signal acquired) in a patient with an angiographically proved posterior fossa dural AVM shows only a cluster of small vessels (arrows) in the left occipital subcutaneous soft tissues. This may be the only CT or MR finding of a dural AVM. (b) Lateral view of a common carotid arteriogram in another patient shows a dural AVM. Branches of the occipital artery (arrows) provide most of the blood supply.

Kelainan Telinga bgn Dalam

Transverse contrast-enhanced CT scan shows calcified (solid arrow) atherosclerotic plaque at the bifurcation of the left common carotid artery, and noncalcified plaque (open arrow) that severely narrows the lumen of the right external carotid artery just above the bifurcation.

Transverse T1-weighted MR image (525/25, one signal acquired) of a dissection of the left internal carotid artery shows hyperintense methemoglobin (black arrow) narrowing the patent lumen of the artery (white arrow). Compare the left internal carotid artery lumen to the lumen of the normal right internal carotid artery (c).

Kelainan Telinga bgn Dalam

Vascular loops adjacent to the eighth cranial nerve. (a) Transverse thin-section T2-weighted spin-echo MR image (4,000/90, four signals acquired) shows the anterior inferior cerebellar artery (open arrows) looping out into the IAC and displacing the nerves, which are seen faintly at the fundus (solid arrow) of the IAC. (b) Coronal reformattion spoiled gradient-recalled acquisition in the steady state, or SPGR, (50/2.4, 30 flip angle) gadolinium-enhanced MR image through the brainstem shows several blood vessels (short arrows) adjacent to the cisternal portions (long arrow) of the left seventh and eighth cranial nerves. It is not possible to determine which vessels these

Kelainan Telinga bgn Dalam

Osseous dysplasias. (a) Transverse CT scan (bone algorithm) in a patient with otosclerosis shows a hypoattenuating halo (black arrow) surrounding the cochlea (cochlear otosclerosis) and overgrowth of abnormal hypoattenuating bone at the fissula ante fenestram (white arrow) (fenestral otosclerosis). (b) Transverse CT scan (bone algorithm) in a different patient who had Paget disease of the skull base shows abnormal hypoattenuating bone (white arrows) encroaching on the normally sclerotic bone (black arrow) of the otic capsule.

Kelainan Telinga bgn Dalam

Vestibular schwannomas. (a) Transverse T1weighted gadolinium-enhanced MR image (783/23, one signal acquired) shows a large tumor extending from the left IAC (arrow) into the cerebellopontine angle cistern. (Reprinted from reference 24.) (b) Transverse thin-section T2weighted MR image (4,000/108, one signal acquired) shows a small, hypointense tumor (arrow) in the fundus of the left IAC. (c) Transverse thin-section contrast-enhanced CT scan (soft-tissue algorithm) shows an enhancing intracanalicular tumor (arrow) filling the left IAC . Compare this to the low attenuation of the normal contents of the right IAC.