醫(yī)學mediastinummodadam的學習資料

醫(yī)學mediastinummodadam的學習資料第1頁/共70頁MediastinumBoundedlaterallybyparietalpleuraofeachlungSuperiormarginisthoracicinletDefinedbyplaneof1stribsInferiormarginisdiaphragmTissueplanesextendsuperiorlyintoneckaroundgreatvessels,tracheaandesophagusConnectstoabdominalcavityviaesophageal,cavalandaortichiatusesConnectstolungsalonghilarvesselsandbronchi第2頁/共70頁MediastinumRadiologicanatomyCXRCTNormalornot?Compartmentsandtheirpathologies:AnteriorMiddlePosterior第3頁/共70頁RadiologicAnatomyLandmarkstolookforonthechestradiograph:TracheaParatrachealstripeDescendingaorticcontourAzygo-esophagealcontour第4頁/共70頁Pneumomediastinumwithcervicalemphysema第5頁/共70頁TrachealaircolumnShouldbestraightSlightbendtorightduetoaorticarchonitsleft.第6頁/共70頁Tracheadeviatestotheleft第7頁/共70頁RightAorticArch第8頁/共70頁RightparatrachealstripeExtendsfromthoracicinlettoazygosveinWidensoutatazygosveinNomorethan3-4mmthick第9頁/共70頁SarcoidOldfilm第10頁/共70頁Aorticcontour第11頁/共70頁Azygo-esophagealrecess第12頁/共70頁Aorticcontourandazygo-esophagealrecessabnormal第13頁/共70頁Normalanatomy:

CT/CXRcorrelation第14頁/共70頁Normalanatomy:

CT/CXRcorrelation第15頁/共70頁Normalanatomy:

CT/CXRcorrelation第16頁/共70頁Normalanatomy:

CT/CXRcorrelation第17頁/共70頁Isthemediastinumwide?Firstask…isittechnical?Positioning:rotated:?AP?Lordotic?Supine?InspirationIfso,repeatthefilmbeforeproceedingtoCT.Thenask…Isitnew?GETOLDFILMS

beforegettingaCTunlesstimeiscritical.第18頁/共70頁30yearoldmaninmotorvehicleaccident第19頁/共70頁APsupineAPuprightPAupright第20頁/共70頁Thinkaboutnormalvariants!VascularstructuresAorticanomaliesTortuousvesselsAzygosveinLipomatosisFatpads第21頁/共70頁Severeasthmaonlongtermsteroids第22頁/共70頁Mediastinallipomatosis第23頁/共70頁第24頁/共70頁PericardialFatPad第25頁/共70頁第26頁/共70頁Tortuousbrachiocephalicvessels第27頁/共70頁第28頁/共70頁AzygoscontinuationoftheIVC—congenitalvariant第29頁/共70頁70yearoldwithdysphagiaTrachealaircolumn第30頁/共70頁Esophagealcancer第31頁/共70頁AbnormalrightparatrachealstripeHodgkinsdisease第32頁/共70頁Abnormalrightparatrachealstripe第33頁/共70頁Checktheoldfilm!2daysearlierHematomafromlineinsertion第34頁/共70頁OneyearagoAbnormalrightparatrachealstripeandaorticarchobscured第35頁/共70頁第36頁/共70頁第37頁/共70頁Tumorobscuringthetopoftheaorticarch第38頁/共70頁AirfluidlevelsThinkbowelorabscess:HiatalherniaZenkerdiverticulumEpiphrenicdiverticulumAchalasiaMediastinalabscess第39頁/共70頁Achalasia第40頁/共70頁Zenkerdiverticulum第41頁/共70頁Hiatalhernia第42頁/共70頁MediastinalabscessafterCABG第43頁/共70頁DifferentialdiagnosisofmediastinalmassesTraditionally,wedividethemediastinumintocompartments.LikelydiagnosisofmassdependsonwhatiscontainedineachcompartmentThesearenotanatomicboundaries,andmassescommonlycrossoverintocompartmentswheretheydon’t“belong”.第44頁/共70頁PosteriormediastinumParaspinalareaMassesusuallyvisibleonlateralfilmoverlyingspineMayobscuredescendingaortacontour第45頁/共70頁PosteriormediastinumNeurogenictumorsSchwannomaSympatheticnervetumorse.g.ganglioneuromaNeurentericcyst,lateralmeningoceleLymphnodes(unusualasonlyareainvolved)ExtramedullaryhematopoesisVertebraltumors,spurs第46頁/共70頁Schwannoma第47頁/共70頁Extramedullaryhematopoesis第48頁/共70頁LateralmeningoceleinNF-1第49頁/共70頁AnteriormediastinumSpaceanteriortogreatvesselsandheart,behindthesternum第50頁/共70頁AnteriormediastinumMostcommon:LymphomaThymiclesionsGermcellorigintumorsThyroidmassesAlso:Foregutcysts,nervetumors,aorticaneurysm,etc.第51頁/共70頁AnteriormediastinalmassesThymichyperplasiateratocarcinomateratomalymphomathymomahemorrhage第52頁/共70頁MiddlemediastinumContainsheart,greatvessels,esophagus,trachea,lymphnodes,nerves.CXRabnormalityinparatrachealarea,azygo-esophagealrecess,retrocardiacareaMaybedifficulttoseeonlateralview第53頁/共70頁MiddleMediastinumLymphnodesForegutcystsVascularlesionse.g.aneurysmBronchogeniccarcinomaHiatalhernia,otheresophagealorGIlesions第54頁/共70頁Lymphoma第55頁/共70頁CardiacevaluationRemember:cardiothoracicratioofabout0.5appliesonlytogoodPAchestx-rays.Knowingwhichchambersformwhichcardiaccontourscanhelpidentifywhatisenlarged.Lookforaccompanyingsigns:PulmonaryvenousengorgementandisolatedLAenlargementsuggestsmitralstenosis.DilatedaortaandLVenlargementsuggestsaorticvalveinsufficiency.第56頁/共70頁NormalheartcontoursLeftatriumLeftventricleRightatrium第57頁/共70頁Leftatrialenlargement-mitralstenosisMitralvalve第58頁/共70頁Leftatrialenlargement“Doubledensity”StraightenedleftheartborderLAenlargedLVnormal第59頁/共70頁EnlargedascendingaortainAS第60頁/共70頁CalcificAorticStenosisEnlargedascendingaorta,normalarch,normaloverallheartsizeLVH第61頁/共70頁LVenlargement第62頁/共70頁Dilatedcardiomyopathymultichanberenlargement第63頁/共70頁ReviewQuestions第64頁/共70頁Amassthatwidenstheparatrachealstripeisprobablyinthe1.Anteriormediastinum2.Middlemediastinum3.Posteriormediastinum4.Neck第65頁/共70頁Posteriormediastinalmassesincludeallexcept:1.Schwannoma2.Extramedullaryhematopoesis3.Thymoma4.Lymphoma第66頁/共70頁Non-pathologicalcausesofmediastinalwideningonachestradiographinclude:1.