醫(yī)學(xué)影像學(xué)課件：呼吸一eng

1、Radiology of Respiratory System() A. Normal X-ray and CT anatomy B. Basic X-ray and CT features in diseases of respiratory system Normal X-ray signs R We m u s t o b s e r v e the diaphragm, the costophrenic angles, chest wall , trachea, heart, hilar shadows, lung fields, position o f t h e l o b e

2、a n d mediastinum in order Thoracic wall Sternocleidomastoid muscle, Pectoralis major muscle The breast and nipple in females Ribs 、Clavicle 、Scapula 、 Sternum 、 Thoracic spine Bones and cartilages Common congenital abnormalities of ribs are cervical rib, bifurcation of rib, and fusion of rib . The

3、sternum, manubrium and thoracic spine are clearly identified in the lateral film. How to observe ribs? Lungs lung fields otransparent zone containing gas divided into an upper, middle and lower lung fields by horizontal lines between the anterior ends of the second and fourth ribs. A BC Lung fields

4、oThe lung field is also divided longitudinally into 3 equal zones by drawing two imaginary lines. oIn the normal upright person, the lower zone vessels are larger than those in the upper zone Lung hilum Composition：Pulmonary arteries, Pulmonary veins ,Bronchi Shape：obtuse angle , knob position： Dens

5、ity: equal R The right concave hilar angle The descending pulmonary artery The superior pulmonary vein The left pulmonary artery The left and right upper bronchus R The hilum of the lung The shadows of the branching pulmonary vessels radiate outward from the hilum and disappear when 2 cm or less fro

6、m the lung margin, with a gradual reduction in size. These branching linear shadows termed the lung markings. They are made up of pulmonary arteries, veins and lymphatics. Lung marking Lung lobes Window Lung window(W 1200, L -600) Mediastinal window(W 300, L 40) The trachea is seen superimposed on t

7、he upper vertebrae at P-A view chest film and divides into right and left main bronchus at the level of 5th or 6th thoracic spine. Trachea bronchi Trachea bronchi Esophagus Heart Trachea oThe anterior part is a shallow space bounded a n t e r i o r l y b y t h e sternum and anteriorly by the pericar

8、dium, a s c e n d i n g a o r t a and the trachea oT h e m i d d l e p a r t contains the trachea, heart, part of aortic arch, superior vena cava and a lot of lymph nodes oT h e p o s t e r i o r mediastinum extends from the posterior a s p e c t o f t h e p e r i c a r d i u m t o the dorsal spine

9、Mediastinum The anterior wall of oesophagus is the boundary of middle and posterior mediastinum oM e d i a s t i n u m i s Divided 9 regions on lateral film. oT h e y a r e c a l l e d a n t e r i o r , m i d d l e , posterior mediastinum and superior, middle,inferior mediastinum. mediastinum The le

10、vel of the right hemi diaphragm is usually near the anterior end of the sixth rib or near the posterior segment of the tenth rib The right hemi diaphragm being up to 1 to 2 cm higher than the left Diaphragm costophrenic angle cardiophrenic angle Diaphragm visceral pleura parietal pleura. oblique and

11、 horizontal fissures pleura horizontal fissures pleura Horizontal Fissure Oblique Fissure oThe normal oblique fissures (major interlobar fissure between the upper and lower lobe) can be seen on good lateral views. oThe oblique fissures begin at the level of the third or fourth thoracic vertebra as a

12、 straight or convex line to the level of the hilum and then extend forwards as a straight or concave line to touch the diaphragm oThe horizontal fissure in the lateral view runs from the hilum straight to the anterior chest wall Pleura pleura BASIC DISORDER X-RAY SIGNS OF RESPIRATORY SYSTEM oExudati

13、ve lesion oProliferative oMass lesion oCavitary lesion oFibrotic lesion oCalcific lesion oInterstitial lesion lung o Pleural effusion oPneumothorax oHydropneumothorax oPleural thickening, adhesion and calcification. Pleuralbronchus oobstructive emphysema oobstructive atelectasis Obstruction of the b

14、ronchus is usually caused by tumor, foreign body, narrow, or exudation etc. Obstruction of the bronchus may results in obstructive emphysema (incomplete obstruction), obstructive atelectasis (complete obstruction) Basic X-ray and CT features in diseases of the bronchus Obstructive emphysema is chara

15、cterized by permanent enlargement of alveoli and is accompanied by destruction of alveolar walls. manifestation: a. Localized ：increase lucency of the affected, lung markings appear as thinner of the involved area, may shift of the mediastinum to the unaffected, pendular movement of the mediastinum

16、on fluoroscopy b. Diffuse：increase lucency of both lungs, lung markings appear thinner than normal, increase in size of the thoracic cavity. Depression and flattening of the diaphragm. emphysema Complete obstruction of the bronchus results in obstructive atelectasis. Atelectasis means incomplete exp

17、ansion of the lung or of a portion of the lung. X-ray feature: a. Homogenous radiopaque shadow. b. The shape and position of the shadow depends on the degree of collapse and which lobe or lobes collapse Obstructive atelectasis X-ray features: a. The affected side presents homogeneous opacity with el

18、evation of hemidiaphragm. b. Displacement of mediastinum to the affected side. c. Narrowing of the intercostals spaces on the affected side. d. Compensatory emphysema on the opposite side lung. Atelectasis of an entire lung Auscultation: low breathing in the right lung X-ray features: a. The affecte

19、d lobe appears as a dense triangular shadow. b. The apex of the triangular shadow at the hilum and its base at the outside. c. Displacement of the hilum and Mediastinum to the affected area. d. Compensatory emphysema in the adjacent lobe.。 lobar atelectasis Collapse of the middle lobe The collapsed

20、lobe is most obvious on the lateral view The middle lobe is opaque and shrink Horizontal of fissure pulled down. Oblique fissure pulled up Atelectasis Oblique fissure Horizontal fissure Definition: The air within the acinus is replaced by pathologic fluid, cell, tissue. It commonly occurs in infecti

21、on, edema, and hemorrhage of lungs. X-ray features: a.The shadow of exudative lesion is radiopaque （alveolar pore）. b.The center of the shadow is dense and the border of the shadow is ill-defined. c. Air bronchogram may be seen in consolidation . d. As a general rule, there is no significant loss of

22、 lung volume in consolidation. Exudative lesion air bronchogram A contrast exist between air-filled intrapulmonary bronchi and the surrounding lung parenchyma, when the lung parenchyma extends into the portion near pulmonary hilum. Air-filled bronchial trees can be visualized in the area of lung par

23、enchyma. Its main component is proliferative fibroblasts, vascular endothelial cell and histocyte. X-ray features: a.It appears as small high density nodules in shape like soy-bean on chest film or CT images. b. The border of the shadow is well- defined. c.Usually, the shadows conglomerate in the up

24、per lung field. The lesion may keep unchanged with a long time period. Proliferative lesion Proliferative lesion There are small high density nodules in shape like soy-bean on chest film of both upper lung field.The border of the shadow is well-defined. mass X-ray features: a. Round, oval or irregul

25、ar in shape. b. Homogeneous and high in density. c. The border of the lesion usually is well-defined. The lobulated mass usually indicate a malignant mass. Nodule(2cm) and Mass lesion ( 2cm) Carcinoma: a irregular shape mass can be seen on the superior segment of the right lower lobe , the boder is

26、well-defined. Carcinoma: a irregular shape mass can be seen on the superior segment of the right lower lobe , the boder is well- defined. Mass lesion can be seen on the right lower lobe , round shape, well-define border. Mass lesion Mass lesion a-b:Carcinoma(irregular shape, ill define border) c-d:h

27、amartoma(round shape, well-define border, calcification in the center) Mililary pulmonary tuberculosis Nodule lesion numerous fine, discrete nodules bilaterally in a random distribution Cavitary lesion The cavity is formed as result of the expulsion of necrotic material into the bronchus, it often s

28、een in pulmonary abscess, tuberculosis and carcinoma. X-ray features: a. a radiolucent shadow with a definite thin( 3mm) or thick ( 3mm) ring wall. b. The inner lining may be smooth or irregular. c. There may be an air-fluid level in the cavity. a cavitary lesion can be seen on the right lower field

29、: a radiolucent shadow with a definite thin( 3mm) ring wall. The inner lining is smooth. Cavitary lesion a radiolucent shadow with a definite thick ring wall. The inner lining is irregular. A number of lung diseases result in pulmonary fibrosis. Fibrosis can represent cellular fibrous tissue charact

30、erized by fibroblast proliferation or dense acellular collagenous tissue. Fibrotic lesion is divided into local and diffuse fibrosis two types. The radiologic signs depend upon the process of disease. Fibrotic lesion Calcific lesion usually represents the healing process of a disease. It is an impor

31、tant sign to the assessment of pulmonary disease, indicating its benignity. Calcification may appear as tiny spots or small nodules or egg- shell-like or popcorn-like or arc shadows. It is very high in density. Calcific lesion hamartoma. CT scan demonstrates popcorn-like calcification within a well-

32、circumscribed 2 cm left lower lobe nodule. Pleural effusions develop when the rate of fluid production is increased, such as in heart failure, or when resorption is impaired, such as in lymphatic obstruction by tumor. The cause of pleural effusion: tuberculosis 、 inflammation、tumor 、trauma Pleural effusion Dull percussion note Small amount moderate amount large amount Pleural effusion Inter