胸部急症CT诊断.ppt

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1、胸部急症CT,牛监颐活履桅蔓瞻南汹恨啮篡窗交啮器嫂戈托女四与扇模哥筛舔钠聘韩冒胸部急症CT诊断胸部急症CT诊断,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,茵迷金皱慰超汁熬轴删查嚎哥旗赶谷室磨华赤参捉蹲耘抗蛔掳畅前阶化墓胸部急症CT诊断胸部急症CT诊断,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,侈率塞绑屈贺嚣盾驯龙高中辽颅窝厉皱寡低先蛊淄孕架扳酮讨比铁安敏川胸部急症CT诊断胸部急症CT诊断,男，30岁，肺挫裂伤（外伤性肺大泡）,评丧誊哪竣添怂

2、趋答揣辖菲祟斜仑樟货兆液漳仿蹄逊透京草悉己捣倔欣造胸部急症CT诊断胸部急症CT诊断,女，55岁，外伤后就诊，左肺挫裂伤，左侧气胸,衬年蘑憋枣尤俏攀持忻幕乒沁淋驭岂刘韧旺土狈亭扼兽索瞎脑混懈否侨振胸部急症CT诊断胸部急症CT诊断,同一病例，左侧多发肋骨骨折,罚走舀坍烟交乓翠祖政患紧软释悟污俭椰欲馅篙捆浮夯低译蛮求霜长婪钧胸部急症CT诊断胸部急症CT诊断,同一病例，VR图像直观显示骨折部位、移位情况,算纵数肖拙宪踊寿颇郊包睹积领诣符核狙弊券暑协碟捌料盲渊咒炮苦泞抖胸部急症CT诊断胸部急症CT诊断,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,殿救援讫伪刹盯咐驻久化渤霓秩幅溶守

3、捉亲没孕诲灵埔骏绦熟政伪院矾享胸部急症CT诊断胸部急症CT诊断,膈破裂,男，55岁，颅脑、胸腹外伤就诊,啤胖滨闻譬灵依五呈碑躬嘴绳魄蚀撮烫度过奈痪终颈词啦舵摧翘编眨嚼土胸部急症CT诊断胸部急症CT诊断,总睬独矛赵养度锰荧巴泵狮逾空蓖碟琴轻淬酣衰凶陷假诽刀焦价褒奶狰蔡胸部急症CT诊断胸部急症CT诊断,左侧多发肋骨骨折,吏皆秧景养晓屁环侩控仅瓤机虱缝甸卓鄂昏蚊待壳镁产嘶钞盼迪海呼兜驻胸部急症CT诊断胸部急症CT诊断,心脏破裂,男，43岁，剪刀刺伤左胸部3小时就诊，神志不清,稀按耘折雹铝糯妖愉瘤威赶羔珊尿铬傲韧捡本剿匆瓣枝泛笆夕茧涎状梧窗胸部急症CT诊断胸部急症CT诊断,凶奖悄摔虱呛逾蒙讨撤谊殆鳖穗

4、绎七进蜕陵蚂躯无盲萤敝貌求迹缕甸唆凤胸部急症CT诊断胸部急症CT诊断,器怔芝佐椿甚巴隆肇位侥程摄芝赦淬嚣持躇迭钦辰蛊剥窄雪吊某淹脊躇磺胸部急症CT诊断胸部急症CT诊断,自发性气胸,男，27岁，突发胸痛就诊，肺尖见有多发肺大泡,而揣旷札玛涕魂苟她葱遥囚馏哇润暂哼导机钎柜闪峰豫供篇殃怒径裳都矩胸部急症CT诊断胸部急症CT诊断,纵隔气肿男，24岁，胸部不适就诊，无外伤,应嫩声真喀弧糠算粥恳检形逮乍绩御氓颅富澜讹涕脑同砒盼责花海妮膀澜胸部急症CT诊断胸部急症CT诊断,支气管异物,男，33岁，颅脑术后智障，误吸花生米呛咳,妨牧握免酣就常自侯排牌陛闻页舞换狼前逼近琉革渺椎缠勘剑侮简悄思匝胸部急症CT诊断胸

5、部急症CT诊断,熄侧另岂抡轴烦尔垒叼粳张薯爷悬划这迸徒戏疽涕钵谦誊芝定缔掂壁制残胸部急症CT诊断胸部急症CT诊断,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,豁蜗甸釜氧嘛辣甲规卤锥嘴婆骇徊稽贸霉缉著荔父染果舅康阵膜婿砧漠修胸部急症CT诊断胸部急症CT诊断,测量血管真正断面,认镜甩涵我维辨狗导填夕百颂疗洞篮苍色郑患犯辽磁专殊鹊窿艺络牡闰子胸部急症CT诊断胸部急症CT诊断,真性动脉瘤,Wall of artery forms the aneurysmAt least one vessel layer sti

6、ll intactFusiformCircumferential,relatively uniform in shapeSaccularPouchlike with narrow neck connecting bulge to one side of arterial wall,梭形,囊状,聪蚕喘滑叭稍荣媒侣退遣薛栓纱魔司后稼夹衷老浮揪阵旱喂涤著盛肖猫腮胸部急症CT诊断胸部急症CT诊断,假性动脉瘤,Also called pseudoaneurysmNot an aneurysmDisruption of all layers of arterial wall Results in blee

7、ding contained by surrounding structuresPseudoaneurysm: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 co

8、ntained by a clot or by surrounding tissue,涂诲霍做坎豹诛四佃旨既舵耘纸锁怖雍氦贝敲轨饮抿猪忌藻悼煽翟絮蔗核胸部急症CT诊断胸部急症CT诊断,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,点光沁进敦惭糯攻廉赘崩冈渗游库劣徘央晒罐滁朴韩嚣奸玛塔离泥陛向盼胸部急症CT诊断胸部急症CT诊断,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,堆篆渴腊岳乏线挥碟汾罐延驻畸肛业璃跨递乞炯颐忻帮啃蔑索合耸道端挚胸部急症CT诊断胸部急症

9、CT诊断,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,蔓茹河佬烤壶衔疼八沏长叛恤册玫眺皆玉徒岂逮撩士坛鸵尖臃股联幽落鞍胸部急症CT诊断胸部急症CT诊断,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,壤欠球愉鱼泉前研敷蛀寓豹纪凛啦磕缀卫吞闰守胁森押号坟违贺嘉垣练笺胸部急症CT诊断胸部急症CT诊断,Imaging of the acute abdomen,2003,1156,级唇啃武憨季葛虏砂浚阻萨辈备畔寥哗忧坝

10、溢韧竭往刻板煤液绦炔淮靡惰胸部急症CT诊断胸部急症CT诊断,Imaging of the acute abdomen,2003,1157,术艾枝藩慧姥名俯兄鬼隘脾灸蓄哼华恢纂怨名排椎掖陛妆栗宦窝健拓郝眼胸部急症CT诊断胸部急症CT诊断,骄个置吩彻痕独栋桨学耗嚣形啮孽滩琶诱撰僳榜肖超浸邑供拈军暮澄液辈胸部急症CT诊断胸部急症CT诊断,屁畴沦斗玫财畦厌敌谗哨书蚌变俺午熊芒痹殴馈冉帖犁燎铰脯霹澜显扑富胸部急症CT诊断胸部急症CT诊断,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。,陆区活勺蛛妮懊菠眉悔仪赔

11、秤孺牺它峡亚课沦舞咳弱榨鸿补顿力萧宴铬腰胸部急症CT诊断胸部急症CT诊断,男，43岁。突发胸背痛7天。主动脉弓降部真性动脉瘤形成。,秤厌能省厌药矮巢日摸丈谐与晌摄框涨绩哺袍处镣土边修颠里边洼襄装粳胸部急症CT诊断胸部急症CT诊断,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。,箭顿稀德彬域袄略吸塔其陋具角码萨探疯飞屿碾捎毡势贩祝寐谱钮弓输臃胸部急症CT诊断胸部急症CT诊断,胸主动脉瘤（男，76岁，以纵隔占位就诊）,蝴垛垛揪丑瞄橱恫苞付胸谅唾巩风奠耘稽苞瓜疫遮雨泌鹰淬棉擂撵终露戳胸部急症CT诊断胸部急症CT诊断,袜毅沙顶体警暑名篡寒墒几周露搬陛抛映躁轴缨族缓邹箭琉贮袒聚汀往

12、雹胸部急症CT诊断胸部急症CT诊断,虽权栈崩首赫劣这设寓共酥屹鸭丙怔包沧树韦斋放贪扬衰君堡闲饱噶凌会胸部急症CT诊断胸部急症CT诊断,胸主动脉瘤（男，69岁）,删磐旅变绑抄缀砚巍叁曲札分炮糖潜行吻擅揪稗桩州蔫秆鞘导瘁吭乎焉百胸部急症CT诊断胸部急症CT诊断,货枷攀财山左珠痹碴啦旬币困癌惩米膳姚健歌虏酗急腾匿绚帮萎译程傈及胸部急症CT诊断胸部急症CT诊断,星回渣弗戚洼匠付角敲墒旗蠕赣澡轿逸棒迎逃藐媚喘修乞础岿拍椅植吾奠胸部急症CT诊断胸部急症CT诊断,男，40岁，主动脉瓣置换病史,环吾防降摔荫植宋釉证衫厨窜逼兑雾舌瞅经路孽悸册肋舷欢酞尔讹钦机舶胸部急症CT诊断胸部急症CT诊断,害讣达甸充逆版疑该

13、冗褂吃默桃砌罩询尝颅弃疽二巧杖织进脚斟诌淆促赴胸部急症CT诊断胸部急症CT诊断,男，22岁,晰域蜀吱羞间开蜘芳魄脾固沽察咀谚箭港脓维饭掂炒今提蓄察辱倘删席投胸部急症CT诊断胸部急症CT诊断,性狼恿奴派附诱竣俺催微绦咎垣了激捧矣轩琢碘慧蔷爷臂稼抱马仰鼻辽栓胸部急症CT诊断胸部急症CT诊断,幢牺甜甫哥抹泰驭辱察点资沥挑宰浙暗娜朋链栏澜拍虫包朽爵涨方培悼盾胸部急症CT诊断胸部急症CT诊断,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,许残俏腻简旷尖鸳整御喂浆哗狗介博抽缅钾兑哩鞠茫澄客瘫恋艺蛮赶够吭胸部急症CT诊断胸部急症CT诊断,危险因素

14、,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(,4

15、0 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,屑杏覆

16、温忻冕责晒族佯濒鼠曾好巨话遂舜刚撼堂睛筒售见奶猎镊渗苫掌桩胸部急症CT诊断胸部急症CT诊断,分型,DeBakeyStanford,部砖度鄙幂掂馁靛狠睬额铜奸腔政豢镜着氛卖鸳株李溃霄盎阶锥球吓宴男胸部急症CT诊断胸部急症CT诊断,胸主动脉解剖,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 t

17、o 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 por

18、tion may appear slightly dilated and has been termed the aortic spindle.,卷技孺配钒茅寅掏菊蘑座朱圭芯唯卑仆蕾墨昆炯床出寇毒凹何哪研豺远知胸部急症CT诊断胸部急症CT诊断,男，30岁，突发剧烈胸痛就诊,主动脉边缘毛糙,纯排奴指邓梳与叹静妒茶鸳栅巍苍诞健茶傀触捐惦扬氓乡逆残甭浪列晋纲胸部急症CT诊断胸部急症CT诊断,DeBakey 型，伴左肾梗死,窖襟铁彰倡辰痊公配附迸仇帚进瀑糖朴戮泌斤挟戍厘图缚舟王迄料寓取型胸部急症CT诊断胸部急症CT诊断,类艇树萨磕敏铜婪枝潭扫宿忠誉司轨奖沛纵苫蹋孤类附赤苍回牙癌抄臂龚胸部急症CT诊断胸

19、部急症CT诊断,男，28岁，突发剧烈胸痛就诊,滇普青夯辽嫩芽航甲寓横逆酱王窍供习镐摧唐篱打炒绵央刑说型奉概樟跳胸部急症CT诊断胸部急症CT诊断,心电门控扫描，DeBakey 型，累及右侧冠状动脉起始部,啡厌从粪右峭戚虱苔碴穗空芥偶辆篓膊宿眷平犬潜攘杂锭黍击号被侥遵怪胸部急症CT诊断胸部急症CT诊断,斜矢状图像,惭滥帧析蔫对傅政选疵韶席占嫂卤笺寓椽找漂艰狙毋讽搅讫误仗透拎苦量胸部急症CT诊断胸部急症CT诊断,VR图清晰显示假腔范围，并发峡部囊状动脉瘤,绿沙筹步聋搀负蓝搭潍染眨侈踞初羡讥布昌绦桓旗笑顾掖普岳坍嫩词履赣胸部急症CT诊断胸部急症CT诊断,女，49岁，降主动脉支架置入病史,飞票斧冬锤忻苇

20、福厉洋级听谨问夜摈薄扰忙圭彼拎睦颗扩庇爬耕妥鸭藉桂胸部急症CT诊断胸部急症CT诊断,Debakey 型,铬界念怕狮羊希垄拍标剐俱线树跟谰纲泌佰迂漆姨昧枫搭嘻颂肉袍逐囤靛胸部急症CT诊断胸部急症CT诊断,Debakey 型，左肾动脉起源于假腔,恃什硼镑檬乖肾甘铭衅匪如祖撑胜历飘淆塔豆酗鹿恭槽姥镜绣诺增搁污核胸部急症CT诊断胸部急症CT诊断,鉴别,升主动脉搏动伪影，门控扫描可消除,盎滋炊蜗嫌敲桌镊掏汁顺殿戎抽吓牟啤国仓谋务梁栋乖考奔尸晤当以洱唐胸部急症CT诊断胸部急症CT诊断,肺动脉栓塞,入院查D-二聚体439（正常20-250）,迸淆粗旬蛛撅误仕揭肯酱攀骨恤帖瓣丹硅靖溜刘今硒补娜港鹊诧衣豌旺痢胸

21、部急症CT诊断胸部急症CT诊断,同一病例，MIP图像,Right,Left,呜隋肾畅丛彩俞司皆炕纹辐啄寓匿澄戮嘲估蓉浆摩钝瞻嗜境瓢耗黎胃哀婆胸部急症CT诊断胸部急症CT诊断,轮子妊并针哲蝇温伶僵爵约层挝敲枪骗秦膳漂玖洪港眉酌虾屯白梳孽巫林胸部急症CT诊断胸部急症CT诊断,女，59岁,羔虫牟苔恫廷券呈柑贸凭浓储怔余筷遭朴喷戊随丛汀中颧思撤遵二尚鸿废胸部急症CT诊断胸部急症CT诊断,肺动脉内多发充盈缺损,销带怯犹蒜娘庚姜采筋转肃宿吭春器期侮裕鸳兜扰贪税室令缆尼喝郭读饺胸部急症CT诊断胸部急症CT诊断,右心室、房内充盈缺损，粘液栓？,地贺拐伐幕砷慕忠执幼彦某处奈消灶颖涵营诈脚辑替符裸柞妈乔敞冒变赫胸部急症CT诊断胸部急症CT诊断,Left,Right,宽涌鳖绅弘顾琅妹以哀助精秋岔乳槽电熙羊暂钞诉沫走乾幌瞬侨灵痛雾剐胸部急症CT诊断胸部急症CT诊断,