1、胸部影像學教學經典選片OverviewImaging MethodsCXR: Main FocusOthers: Computed Tomography, MRI, Ultrasound, Nuclear MedicineApproach to CXRDensitiesAnatomy and approachTechnical FactorsOverview contdAbnormal CXR findingsBoneCardiovascularAirspace Disease and Silhouette SignInterstitial Disease with emphasis on p

2、ulmonary edemaOther Lung Disease: Atelectasis, NodulePleuraMediastinal Other Imaging MethodsCXR-Will be discussed laterComputed TomographyMRIUltrasoundMainly for proceduresNuclear MedicineComputed TomographyNumerous protocols/techniques depending on clinical history Helical/spiral versus high resolu

3、tionContrastRenal failureAllergyComputed TomographyRole of CTMain further investigation for most CXR abnormality (eg nodule/mass) or to exclude disease with normal CXRMain investigation for certain scenarios (PE, dissection, trauma)Radiation DoseCompare dose to normal background radiation (3mSv/year

4、)CXR PA view:3 daysCXR PA Lat:18 daysLow Dose CT:0.5 yearHRCT:1 yearHelical CT:2-3 yearsMRIMultiple planesNo radiationCommon IndicationPancoast tumourBrachial plexusCardiacVascular (aorta)Usually targeted examination (unlike CT)CoronalNuclear MedicineVariety of tests: functional rather than anatomic

5、V/Q specific to chest imagingOthers: bone scan, gallium, WBC etc.UltrasoundLimited use in thorax (non cardiac) due to air in lungsAssess pleural effusionsMainly used for proceduresChest RadiographsPA (posterior to anterior) and Lateral (left)Minimizes magnification of heart (heart closest to film)Po

6、rtable (nearly always AP)Supine or ErectSpecialized ViewsLordoticLateral decubitus (for effusions, pneumothorax)Chest Radiograph: Approach andNormal AnatomyTHERE IS NO ONE APPROACH: BE SYSTEMATICBone and Soft Tissue including abdomenHeartMediastinum-aorta, tracheaHilaPulmonary VasculatureLungsPleura

7、Normal AnatomyBone-CT ReconstructionPA ViewClavicleRibIntercostal SpaceVertebral ColumnSternumRibBone AnatomyHeart SizeNormal is LateralPA in sensitivityPneumothoraxUprightDeep sulcus sign in supineSmall Pleural EffusionSmall Pleural EffusionNormal:Sharp AnglesBlunted posterior costophrenic sulcusLa

8、rge Pleural EffusionLateral DecubitusSupine PatientPleural Effusion in Supine PatientPleural effusion layers posteriorly in a supine positionCause diffuse increased density Diagnosis?Which is a pneumothorax?ptxinspexpInspirationExpirationhugeptxCollapsed Right LungTension Pneumothorax: Requires ches

9、t tube Tracheal DeviationWhat would you do with this patient?ptxdeepsulcusSupine PatientDeep SulcusNon Dependent Portion of Lung in at Base in Supine PatientDeep Sulcus: What can you do to confirm?pxtdeepsulcuslatdecubLeft lateral decubitusMediastinum: OverviewClassification of MediastinumExamples o

10、f mediastinal massesClassification of MediastinumAnatomicSuperior: above sternal angleAnteriorMiddle: heart and pericardiumPosteriorThere are radiographic classification e.g. FelsonsANATOMIC CLASSIFICATIONThe mediastinum is divided into 4 partsSuperior mediastinumApex of thorax to a plane passing th

11、rough the manubrio-sternal junction and fourth dorsal vertebral bodyAnterior mediastinum Is anterior to heart & great vesselsMiddle mediastinumContains heart & great vessels, lymph nodesPosterior mediastinumContains descending thoracic aorta, azygous/hemiazygous veins,esophagus, thoracic duct, nerve

12、s & lymph nodesClassification of MediastinumAnterior Mediastinal MassThe 4 TsThyroidThymus (Thymoma)TeratomaTerrible Lymphoma (Tumour)Thyroid GoiterMost common superior mediastinal mass extending to thoracic inletNote Tracheal DeviationbenignthymomaNormalLateral shows mass is anteriorNORMALComputed

13、TomographyThymoma: Do you know of any associatedclinical syndrome?Hiatus herniaLymphadenopathyLymphadenopathyLungCancerSmall cell ctWhere is the Lymphadenopathy?Rt. ParatrachealLymphadenopathy(Lymphoma)Paratracheal and Hilar Lymphadenopathy: ?DiagnosisNormalHilar and Mediastinal LymphadenopathyDiagn

14、osis?Hilar Lymphadenopathy on lateralNormalSarcoidosisCases27 y.o presents with fever and cough. Diagnosis?Normal60 y.o. male with onset of SOB. Diagnosis?pulmedema60 yo with SOB. Diagnosis?baselineSame Patients Baseline: Pulmonary Edema has resolvedDiagnosis: LUL Consolidation40 y.o female with cough and fever.50 y.o female with progressive SOB. What can you do to improve SOB?Post Chest Tube InsertionLarge Pleural Effusion60 y.o recently admitted to ICU with droppi