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Abstrak :
We reported here a rare case of a 62 year old male patient with obstructive jaundice due to bile duct tumor. The main clinical features were yellowish eye and skin, followed by pruritus and clay-colored stool. Ultrasonography showed common bile duct dilatation and without evidence of stones. Computed Tomography Scan of upper abdomen showed a mass which were thought of head of pancreas origin. Endoscopic Retrograde Cholangio Pancreatograph revealed tight narrowing of the distal bile duct to a malignant tumor. A stent was inserted to allow biliary drainage, A surgical plan for billio digestive anastomosis was rejected by the patient and family.

Abstrak :
CT-scan abdomen merupakan opsi dalam penegakan diagnosis terkait dengan dugaan penyakit yang diderita pasien menggunakan radiasi pengion, namun resiko radiasi pada organ sensitif di sekitar area abdomen dapat menimbulkan kekhawatiran tersendiri. Maka dari itu, dilakukan penelitian untuk menunjukkan seberapa besar dosis radiasi yang diterima organ sensitif (gonad, payudara, tiroid dan mata) pada pelaksanaan pemeriksaan CT abdomen, dengan fantom rando sebagai objek pemeriksaan dan TLD rod sebagai penangkap radiasi. Pelaksanaan pemeriksaan dilakukan dengan memvariasikan kV (80,120 dan 140) dan nilai pitch (4,6 dan 8). Dosis radiasi terbesar didapatkan pada gonad dengan 7,67 mGy dan terendah pada tiroid kanan dengan 0,01 mGy. Sehingga, dapat disimpulkan bahwa pemeriksaan CT-scan abdomen tidak menimbulkan efek langsung. ......CT-scan for abdomen area is an examination option in diagnosis that related to patient’s disease, but the radiation risk that appears on sensitive organs near abdomen area need to be concern. Therefore, a research was done to show how much radiation dose for organs received (gonad, breasts, thyroids, and eyes) in CT-scan examination for abdomen, using rando phantom as an object and TLD rod as dosemeter. The variation of examination was done for kV (80, 120, and 140) and pitch (4, 6, and 8). The result show that gonad had received the highest radiation dose with 7,674 mGy (tube’s voltage was 140 kV, pitch 6). So, it can be concluded that examination with CT-scan did not give deterministic effect to sensitive organs.

Abstrak :
Latar Belakang: Kanker pankreas merupakan penyakit dengan kesintasan rendah dan kesulitan untuk melakukan diagnosis. Pemeriksaan Computed Tomography (CT)-Scan abdomen dan Ca 19-9 merupakan modalitas yang murah, mudah, dan terjangkau dalam diagnosis kanker pankreas. Endoscopic Ultrasound Fine Needle Aspiration (EUS-FNA) merupakan pemeriksaan baku emas untuk diagnosis kanker pankreas tetapi belum banyak tersedia di fasilitas kesehatan di Indonesia Tujuan: Penelitian ini bertujuan untuk mengetahui kemampuan diagnostik CT-Scan abdomen dan Ca 19-9 dibandingkan dengan EUS-FNA dalam diagnosis kanker pankreas. Metode: Desain studi ini adalah potong lintang dengan melihat rekam medis 62 pasien dengan kecurigaan kanker pankreas di RSCM pada tahun 2015-2019. Diambil pasien-pasien yang memiliki data Ca 19-9 dan CT-Scan abdomen yang kemudian dilakukan EUS-FNA untuk penegakan diagnosis kanker pankreas. Hasil: Sensitivitas dan spesifisitas CT-Scan abdomen masing-masing 76,27% dan 100%, sedangkan Ca 19-9 masing-masing 67,8% dan 33,33%. Nilai duga positif (NDP), nilai duga negatif (NDN), rasio kemungkinan positif (RKP), rasio kemungkinan negatif (RKN), dan akurasi CT-Scan abdomen masing-masing adalah 100%, 17.65%, tidak dapat dinilai, 0,24 , dan 77,42%. Nilai duga positif, NDN, RKP, RKN, dan akurasi untuk Ca 19-9 masing-masing adalah 95.24%, 5%, 1,02, 0,97, dan 66,13%. Kesimpulan: Kombinasi pemeriksaan CT-Scan Abdomen dan Ca 19-9 memiliki sensitivitas yang tinggi untuk kanker pankreas. Computed Tomography abdomen dapat digunakan untuk diagnosis kanker pankreas dengan sensitivitas dan spesifisitas yang baik.

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Introduction: Pancreatic cancer is a disease with low survival rate and difficult to diagnose. Abdominal computed tomography (CT) and Ca 19-9 are diagnostic modalities which are easy, simple, and non-invasive in diagnosis of pancreatic cancer. Endoscopic Ultrasound Fine Needle Aspiration (EUS-FNA) is the gold standard for diagnosis of pancreatic cancer but it is not available in many health care facilities in Indonesia. Purpose: This study aims to know the diagnostic accuracy of abdominal CT and Ca 19-9 compared to EUS-FNA for diagnosis of pancreatic cancer. Methods: The design of this study is cross-sectional by searching medical record of 62 patients with clinical suspicion of pancreatic cancer in Cipto Mangunkusumo hospital from year 2015-2019. Patients who undergo EUS-FNA with clinical suspicion of pancreatic cancer and have abdominal CT and Ca 19-9 data is included. Results: The sensitivity and specificity of abdominal CT are 76.27% and 100%, respectively, and Ca 19-9 are 67.8% and 33.33%, respectively. Positive predictive value, NPV, positive likelihood ratio, negative likelihood ratio, and accuracy of abdominal CT are 100%, 17.65%, unmeasurable, 0.24 , and 77.42%, respectively. Positive predictive value, NPV, positive likelihood ratio, negative likelihood ratio, and accuracy of Ca 19-9 are 95.24%, 5%, 1.02, 0.97, and 66.13%, respectively. Conclusion: The combined sensitivity of abdominal CT and Ca 19-9 has high sensitivity to diagnose pancreatic cancer. Abdominal CT can be used to diagnose pancreatic cancer with good sensitivity and specificity.

Abstrak :
Extra-pulmonary tuberculosis covers all forms of tuberculosis in which the disease process occurs outside the lungs. Tuberculosis is one of the common infectious causes of splenic enlargement, but tuberculous splenic abscess is a rare presentation. We report the finding of tuberculous multiple splenic abscesses in a young male patient aged 33 years with prolonged fever. The main clinical feature was fever for 6 months prior to admission. Abdominal ultrasound revealed the spleen was normal in size but showed multiple abscesses. CT scan abdomen showed splenomegaly with multiple solid nodules. Patient underwent laparatomy and splenectomy, the spleen indeed showed multiple abscesses. Histopatology result showed Langhan's multi nucleated giant cells, caseous necrosis. The patients was diagnosed to have tuberculous multiple abscesses of the spleen. The patient was started on daily short-course antituberculosix drugs with isoniazid, rifampicin, pyrazinamide and ethambutol. He responded well to oral antituberculosis treatment.