LAPORAN JAGA

MINGGU, 25 DESEMBER 2016

KONSULEN JAGA:
dr. Pande Putu Yuli Anandasari, Sp. Rad
dr. Ni Nyoman Margiani, Sp. Rad

Residen Jaga: Ratna

 JUMLAH KASUS

Konvensional: 82
CT Scan: 14
USG: 5
 KASUS I

NO RM: 160539XX
LAKI-LAKI
34 TAHUN
KLINIS: SUSPECT APPENDICITIS AKUT
 USG ABDOMEN ATAS BAWAH

Ginjal kanan: ukuran normal, echocortex normal, batas sinus cortex jelas, pelviocalyceal system tidak melebar, tak
tampak batu/ massa/ kista
Ginjal kiri : ukuran normal, echocortex normal, batas sinus cortex jelas, pelviocalyceal system tidak melebar, tak tampak
batu/ massa/ kista
Buli: terisi urin minimal, dinding buli tampak menebal, tak tampak batu/massa
Prostat: ukuran normal, parenchym normal, tak tampak kalsifikasi
Tak tampak echocairan bebas pada cavum abdomen danc avum pelvis
Regio Inguinal kanan: tampak lesi tubuler non compressible paad regio inguinal kanan dengan gambaran hypoechoic di
sentral dan isoechoic pada dindingnya, terukur dinding > 3mm dengan vaskularisasi (+), nyeri tekan transduser (+)

Kesan: gambaran appendix dengan tanda-tanda inflamasi pada regio inguinal kanan
Cystitis kronis
 APPENDICITIS AKUT
Etiology

Obstruction of appendiceal lumen by

Lymphoid hyperplasia
Fecolith
Foreign bodies
Stricture
Tumor
Parasite
Crohns disease

Clinical findings

RLQ pain over appendix is a positive McBurney sign

Leukocytosis
Fever
Nausea and vomiting
Relatively higher rate of misdiagnosis in women between ages 20-40
May have an atypical location
 IMAGING FINDINGS
Abdominal plain film (abnormalities seen in <50%)
Plain-film findings become more distinctive after perforation, while clinical findings subside
Calcified, frequently laminated, appendicolith in RLQ (in 7-15%)
Appendicolith and abdominal pain = 90% probability of acute appendicitis
Appendicolith in acute appendicitis means a high probability for perforation

"Cecal ileus" = local paralysis

Small bowel obstruction pattern
Soft-tissue mass and paucity or absence of intestinal gas in RLQ (more often with perforation)
Extraluminal gas bubbles (again more often in perforation)
Large pneumoperitoneum is rare because etiology of appendicitis involves obstruction of a very
small lumen
Focal increase in thickness of lateral abdominal wall
Loss of properitoneal fat line on right side
 BE / UGI (accuracy 50-84%):Failure to fill appendix with barium (normal
finding in up to 35%)
Indentation along medial wall of cecum (from edema at base of appendix /
matted omentum / periappendiceal abscess)
 ULTRASOUND
US (77-94% sensitive, 90% specific, 78-96% accurate)Useful in ovulating women
(false-negative appendectomy rate in males 15%, in females 35%):
Visualization of noncompressible appendix as a blind-ending tubular aperistaltic
structure (seen only in 2% of normal adults, but in 50% of normal children)
Target appearance of >6 mm in total diameter on cross section (81%)
Mural wall thickness >2 mm

Diffuse hypoechogenicity (associated with higher frequency of perforation)

Lumen may be distended with anechoic / hyperechoic material
Loss of wall layers
Visualization of appendicolith (6%)
Localized periappendiceal fluid collection
Prominent hyperechoic mesoappendix / pericecal fat
 Color Doppler US:Increased conspicuity from increase (in size + number) of
vessels in and around the appendix
Decreased resistance of arterial waveforms
Continuous / pulsatile venous flow
 CT (87-98% sensitive, 83-97% specific, 93% accurate)
Distended lumen
Circumferentially thickened and enhancing wall
Appendicolith = homogeneous / ringlike calcification (25%)
Periappendicular inflammation-linear streaky densities in periappendicular fat
Pericecal soft-tissue mass
Abscess
Poorly encapsulated
Single or multiple fluid collection(s) with air
Extraluminal contrast material
Focal cecal wall thickening (80%)