胸片读片和心影改变.pptx

胸片阅读与心影改变胸片阅读与心影改变谭洪毅胸片读片和心影改变1/37X-rays-describe radiation which is part of thespectrum which includes visible light,gamma rays and cosmic radiation.Unlike visible light,radiation passes through stuff.When you shine a beam of X-Ray at a person and put a film on the other side of them a shadow is produced of the inside of their body.胸片读片和心影改变2/37Different tissues in our body absorb X-rays at different extents:Bone-high absorption(white)Tissue-somewhere in the middle absorption(grey)Air-low absorption(black)胸片读片和心影改变3/37Be systematic:1)Check the quality of the film 胸片读片和心影改变4/37Film QualityFirst determine is the film a PA or AP view.PA-the x-rays penetrate through the back of the patient on to the filmAP-the x-rays penetrate through the front of the patient on to the film.All x-rays in the PICU are portable and are AP view胸片读片和心影改变5/37Film Quality(cont)Was film taken under full inspiration?-10 posterior ribs should be visible.Why do I say posterior here?When X-ray beams pass through the anterior chest on to the film Under the patient,the ribs closer to the film(posterior)are most apparent.A really good film will show anterior ribs too,there shouldBe 6 to qualify as a good inspiratory film.胸片读片和心影改变6/37胸片读片和心影改变7/37Quality(cont.)Is the film over or under penetrated if under penetrated you will not be able to see the thoracic vertebrae.胸片读片和心影改变8/37Quality(cont)Check for rotationDoes the thoracic spine align in the center of the sternum and between the clavicles?Are the clavicles level?胸片读片和心影改变9/37Verify Right and Left sidesGastric bubble should be on the left胸片读片和心影改变10/37X线线一、心胸比:心脏横径与胸廓横径之比.正常值:0.5,分为三度,0.510.55 为轻度、0.560.60为中度、大于0.60为高度增大。缺点:受体型,横膈位置影响大,横位心及垂位心较大误差;不能反应心脏前后径增大。胸片读片和心影改变11/37心胸比测量示意图一心胸比等于：T1T2/Th；T1：右心缘距中线最大距离；T2：左心缘距中线最大距离；Th：胸廓横径，以经过右膈顶上缘测量胸廓横径为准。摘自刘玉清主编胸片读片和心影改变12/37B：心脏横径，两心缘最凸点垂直线之间距离。A：胸廓最大横径。心胸比：B/A摘自心胸比测量示意图二胸片读片和心影改变13/37二、心高比：取右心房与大血管交点至右心膈角水平线垂直距离为右心房高，取主动脉弓项至右心膈角水平线垂直距离为心高，二者之比右心房一心高比率。平均0.46 0.04,反应右心房增大.。胸片读片和心影改变14/37三、主，肺动脉测量胸片读片和心影改变15/371升主动脉宽径(A1)，以升主动脉右缘最凸点至中线垂直距离计(假如升主动脉外缘不清，可按上腔静脉外缘计)。100例青壮年测 量(下同)：平均2.580.48cm。2主动脉结宽径(A2)，主动脉结最凸点至大气管左线主动脉结压迹最凹距离。平均276土0.28厘米。3主动脉长径(A3)，自右心缘大血管与右心房交点至主动脉结最凸点距离。平均935土161厘米。胸片读片和心影改变16/371肺动脉段基线(P1)；主动脉结肺动脉交点与肺动脉左心房耳部(或左心室)交点连线。平均4.880.72cm。2主肺动脉干横径(P2)：自肺动脉段最凸点（或最凹点，如平直则取其中点)至正中线垂直距离。平均3.86 0.53。3肺动脉段凸出度(P3)：自肺动脉段最凸点(或最凹点)至肺动脉段基线垂直距离，假如肺动脉段为平直则其凸出废为0，凸出者为正值，凹陷者为负数。平均0.110.28cm。4.右下肺动脉干横径(P4):右下肺动脉干上端外缘至中间段支气管外缘距离,正常1.5cm。（摘自临床心脏X线诊疗学刘玉清主编）胸片读片和心影改变17/37正位解剖胸片读片和心影改变18/37侧位解剖胸片读片和心影改变19/37胸片读片和心影改变20/37动脉导管未闭-肺动脉段突出胸片读片和心影改变21/37房缺-肺动脉段突出胸片读片和心影改变22/37二尖瓣狭窄-左房大胸片读片和心影改变23/37左房大胸片读片和心影改变24/37室间隔缺损-肺动脉段突出胸片读片和心影改变25/37室间隔缺损-直径2.5cm胸片读片和心影改变26/37法乐四联症-肺血少胸片读片和心影改变27/37二尖瓣狭窄-肺间质水肿胸片读片和心影改变28/37冠心病动脉硬化胸片读片和心影改变29/37高血压心脏病心衰-肺泡肺水肿胸片读片和心影改变30/37肺动脉高压胸片读片和心影改变31/37肺动脉瓣狭窄-右心扩大胸片读片和心影改变32/37扩心病-左心大胸片读片和心影改变33/37肥厚性心肌病-肺血正常胸片读片和心影改变34/37缩窄性心包炎胸片读片和心影改变35/37心包积液胸片读片和心影改变36/37心包囊肿胸片读片和心影改变37/37