胸部急症C诊断.ppt

单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,胸部急症,CT,胜利油田中心医院,CT,检查科 宋殿行,2013-10-09,大致分类,胸外伤,自发性气胸,支气管异物,心包填塞,主动脉瘤,(,非急症,),主动脉夹层,2013-10-09,胸外伤,原因：车祸、摔伤、火器伤、刀刺伤,阳性征象：,胸廓骨折,肺挫裂伤，肺挫伤,肺裂伤肺内血肿肺气囊,胸腔积液、气胸、纵隔气肿，颈胸部皮下及肌间气肿,心脏、大血管损伤,膈肌损伤,2013-10-09,男，,30,岁，肺挫裂伤（外伤性肺大泡）,2013-10-09,女，,55,岁，外伤后就诊，左肺挫裂伤，左侧气胸,2013-10-09,同一病例，左侧多发肋骨骨折,2013-10-09,同一病例，,VR,图像直观显示骨折部位、移位情况,2013-10-09,男，,43,岁，外伤就诊，矢状位图像示胸骨骨折、纵隔气肿，脊柱多发骨折,2013-10-09,膈破裂,男，55岁，颅脑、胸腹外伤就诊,2013-10-09,2013-10-09,左侧多发肋骨骨折,2013-10-09,心脏破裂,男，,43,岁，剪刀刺伤左胸部,3,小时就诊，神志不清,2013-10-09,2013-10-09,2013-10-09,自发性气胸,男，,27,岁，突发胸痛就诊，肺尖见有多发肺大泡,2013-10-09,纵隔气肿,男，,24,岁，胸部不适就诊，无外伤,2013-10-09,支气管异物,男，,33,岁，颅脑术后智障，误吸花生米呛咳,2013-10-09,2013-10-09,动脉瘤,定义：主动脉扩张,1.5,倍正常管径,升主动脉,5cm,，主动脉弓、胸主动脉,4cm,，远侧腹主动脉,3cm,原因：,变性,外伤,感染,分类：,真性,假性,2013-10-09,2013-10-09,测量血管真正断面,真性动脉瘤,Wall of artery forms the aneurysm,At least one vessel layer still intact,Fusiform,Circumferential,relatively uniform in shape,Saccular,Pouchlike with narrow neck connecting bulge to one side of arterial wall,梭形,囊状,2013-10-09,假性动脉瘤,Also called pseudoaneurysm,Not an aneurysm,Disruption of all layers of arterial wall,Results in bleeding contained by surrounding structures,Pseudoaneurysm:an outpouching of a blood vessel,involving a defect in the two innermost layers(the tunica intima and media)with continuity of the outermost layer,the adventitia.,Alternatively,all three layers are damaged and bleeding outside of the vessel is contained by a clot or by surrounding tissue,2013-10-09,病理,真性：动脉壁各层完整，但被延伸,假性动脉壁各层被穿透，瘤壁为纤维组织,2013-10-09,影像诊断,要点：局限性或弥漫型扩张,形状与病因关系：,梭形动脉瘤多继发于变性（与年龄因素相关）,局限并偏心性，多提示感染后、外伤后起源,常规需测量主动脉瘤的,外径,2013-10-09,提供信息,瘤体直径及累及范围,与主动脉主要分支的关系,血管腔内血栓的情况,是否存在泄露、破裂出现的周围渗出性改变,是否存在周围脂肪的炎性改变,2013-10-09,动脉瘤泄露、破裂征象,轻微：,动脉瘤附近的模糊区域或对比剂局限性聚集（动脉瘤与脊柱之间）,明显：,血肿临近或围绕动脉瘤,纵隔或腹膜后腔的血肿,胸腹腔积血,2013-10-09,Imaging of the acute abdomen,2003,1156,2013-10-09,Imaging of the acute abdomen,2003,1157,2013-10-09,2013-10-09,2013-10-09,男，,57,岁,发作性心慌、胸闷,2,月余,术前,CT,（上组图）示升主动脉瘤样扩张，主动脉瓣增厚,术后,CT,（下组图）示升主动脉部分人工血管置换，主动脉瓣置换。,2013-10-09,男，,43,岁。突发胸背痛,7,天。主动脉弓降部真性动脉瘤形成。,2013-10-09,2013-10-09,男，,34,岁。活动后胸背部疼痛,7,天。,CT,示主动脉弓降部假性动脉瘤形成。,胸主动脉瘤,（男，,76,岁，以纵隔占位就诊）,2013-10-09,2013-10-09,2013-10-09,胸主动脉瘤,（男，,69,岁）,2013-10-09,2013-10-09,2013-10-09,男，,40,岁，主动脉瓣置换病史,2013-10-09,2013-10-09,男，,22,岁,2013-10-09,2013-10-09,2013-10-09,2013-10-09,主动脉夹层,主动脉夹层指主动脉腔内的血液通过内膜的破口进入主动脉壁中层而形成的壁内血肿，并非主动脉壁的扩张,危险因素,Common predisposing factors in the International Registry of Aortic Dissection(IRAD)were hypertension in 72%of cases,followed by atherosclerosis in 31%and previous cardiac surgery in 18%,国际主动脉夹层官方记录（,IRAD,）显示，最常见的危险因素为高血压，占病例的,72,；其次为动脉粥样硬化，占,31,；心脏手术史，占,18,Analysis of the young patients with dissection(,40 years of age)revealed that younger patients were less likely to have a history of hypertension(34%)or atherosclerosis(1%),but were more likely to have Marfan syndrome,bicuspid aortic valve,and/or prior aortic surgery,针对年轻患者的分析显示年轻患者（,40,岁）较少有高血压病史（占,34,）及动脉粥样硬化史（,1,），而马凡氏综合征史、主动脉瓣双瓣畸形和（或）主动脉手术史可能性更大,2013-10-09,分型,DeBakey,Stanford2013-10-09,胸主动脉解剖,2013-10-09,Anatomy of the thoracic aorta and significant landmarks.,The ascending aorta,extends from the aortic valve to the origin of the innominate artery.Its proximal portion,in relation to the aortic valve and sinuses of Valsalva,is termed the aortic root,.The aortic arch,begins at the innominate artery and ends at the ligamentum arteriosum.Its most distal part,which is often slightly narrowed,is termed the,aortic isthmus,.The descending aorta begins at the ligamentum.Its proximal portion may appear slightly dilated and has been termed the aortic spindle.,2013-10-09,男，,30,岁，突发剧烈胸痛就诊,主动脉边缘毛糙,DeBakey,型，伴左肾梗死,2013-10-09,2013-10-09,男，,28,岁，突发剧烈胸痛就诊,2013-10-09,2013-10-09,心电门控扫描，,DeBakey,型，累及右侧冠状动脉起始部,斜矢状图像,2013-10-09,VR,图清晰显示假腔范围，并发峡部囊状动脉瘤,2013-10-09,女，,49,岁，降主动脉支架置入病史,2013-10-09,2013-10-09,Debakey,型,Debakey,型，左肾动脉起源于假腔,2013-10-09,鉴别,升主动脉搏动伪影，门控扫描可消除,2013-10-09,肺动脉栓塞,入院查,D-,二聚体,439,（正常,20-250,）,2013-10-09,同一病例，,MIP,图像,Right,Left,2013-10-09,2013-10-09,女，,59,岁,2013-10-09,肺动脉内多发充盈缺损,2013-10-09,右心室、房内充盈缺损，粘液栓？,2013-10-09,Left,Right,2013-10-09,2013-10-09,希望有所收获,