胸部急癥CT診斷課件

1、胸部急癥CT勝利油田中心醫(yī)院CT檢查科 宋殿行2013-10-09大致分類胸外傷自發(fā)性氣胸支氣管異物心包填塞主動(dòng)脈瘤(非急癥)主動(dòng)脈夾層2013-10-09胸外傷原因：車禍、摔傷、火器傷、刀刺傷陽(yáng)性征象：胸廓骨折肺挫裂傷，肺挫傷肺裂傷肺內(nèi)血腫肺氣囊胸腔積液、氣胸、縱隔氣腫，頸胸部皮下及肌間氣腫心臟、大血管損傷膈肌損傷2013-10-09男，30歲，肺挫裂傷（外傷性肺大泡）2013-10-09女，55歲，外傷后就診，左肺挫裂傷，左側(cè)氣胸2013-10-09同一病例，左側(cè)多發(fā)肋骨骨折2013-10-09同一病例，VR圖像直觀顯示骨折部位、移位情況2013-10-09男，43歲，外傷就診，矢狀位圖像

2、示胸骨骨折、縱隔氣腫，脊柱多發(fā)骨折2013-10-09膈破裂男，55歲，顱腦、胸腹外傷就診2013-10-092013-10-09左側(cè)多發(fā)肋骨骨折2013-10-09心臟破裂男，43歲，剪刀刺傷左胸部3小時(shí)就診，神志不清2013-10-092013-10-092013-10-09自發(fā)性氣胸男，27歲，突發(fā)胸痛就診，肺尖見(jiàn)有多發(fā)肺大泡2013-10-09縱隔氣腫男，24歲，胸部不適就診，無(wú)外傷2013-10-09支氣管異物男，33歲，顱腦術(shù)后智障，誤吸花生米嗆咳2013-10-092013-10-09動(dòng)脈瘤定義：主動(dòng)脈擴(kuò)張1.5倍正常管徑 升主動(dòng)脈5cm，主動(dòng)脈弓、胸主動(dòng)脈4cm，遠(yuǎn)側(cè)腹主動(dòng)脈3

3、cm原因：變性外傷感染分類：真性假性2013-10-092013-10-09測(cè)量血管真正斷面真性動(dòng)脈瘤Wall of artery forms the aneurysmAt least one vessel layer still intactFusiformCircumferential, relatively uniform in shapeSaccularPouchlike with narrow neck connecting bulge to one side of arterial wall梭形囊狀2013-10-09假性動(dòng)脈瘤Also called pseudoaneurysmN

4、ot an aneurysmDisruption of all layers of arterial wall Results in bleeding 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. Altern

5、atively, all three layers are damaged and bleeding outside of the vessel is contained by a clot or by surrounding tissue2013-10-09病理真性：動(dòng)脈壁各層完整，但被延伸假性：動(dòng)脈壁各層被穿透，瘤壁為纖維組織2013-10-09影像診斷要點(diǎn)：局限性或彌漫型擴(kuò)張形狀與病因關(guān)系：梭形動(dòng)脈瘤多繼發(fā)于變性（與年齡因素相關(guān)）局限并偏心性，多提示感染后、外傷后起源常規(guī)需測(cè)量主動(dòng)脈瘤的外徑2013-10-09提供信息瘤體直徑及累及范圍與主動(dòng)脈主要分支的關(guān)系血管腔內(nèi)血栓的情況是否存在泄露

6、、破裂出現(xiàn)的周圍滲出性改變是否存在周圍脂肪的炎性改變2013-10-09動(dòng)脈瘤泄露、破裂征象輕微：動(dòng)脈瘤附近的模糊區(qū)域或?qū)Ρ葎┚窒扌跃奂▌?dòng)脈瘤與脊柱之間）明顯：血腫臨近或圍繞動(dòng)脈瘤縱隔或腹膜后腔的血腫胸腹腔積血2013-10-09Imaging of the acute abdomen,2003,11562013-10-09Imaging of the acute abdomen,2003,11572013-10-092013-10-092013-10-09男，57歲發(fā)作性心慌、胸悶2月余術(shù)前CT（上組圖）示升主動(dòng)脈瘤樣擴(kuò)張，主動(dòng)脈瓣增厚術(shù)后CT（下組圖）示升主動(dòng)脈部分人工血管置換，主動(dòng)脈瓣

7、置換。2013-10-09男，43歲。突發(fā)胸背痛7天。主動(dòng)脈弓降部真性動(dòng)脈瘤形成。2013-10-092013-10-09男，34歲?；顒?dòng)后胸背部疼痛7天。CT示主動(dòng)脈弓降部假性動(dòng)脈瘤形成。胸主動(dòng)脈瘤（男，76歲，以縱隔占位就診）2013-10-092013-10-092013-10-09胸主動(dòng)脈瘤（男，69歲）2013-10-092013-10-092013-10-09男，40歲，主動(dòng)脈瓣置換病史2013-10-092013-10-09男，22歲2013-10-092013-10-092013-10-092013-10-09主動(dòng)脈夾層主動(dòng)脈夾層指主動(dòng)脈腔內(nèi)的血液通過(guò)內(nèi)膜的破口進(jìn)入主動(dòng)脈壁中層

8、而形成的壁內(nèi)血腫，并非主動(dòng)脈壁的擴(kuò)張危險(xiǎn)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% 國(guó)際主動(dòng)脈夾層官方記錄（IRAD）顯示，最常見(jiàn)的危險(xiǎn)因素為高血壓，占病例的72；其次為動(dòng)脈粥樣硬化，占31；心臟手術(shù)史，占18 Analysis of the young

9、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 針對(duì)年輕患者的分析顯示年輕患者（40歲）較少有高血壓病史（占34）及動(dòng)脈粥樣硬化史（1），而

10、馬凡氏綜合征史、主動(dòng)脈瓣雙瓣畸形和（或）主動(dòng)脈手術(shù)史可能性更大2013-10-09分型DeBakeyStanford2013-10-09胸主動(dòng)脈解剖2013-10-09Anatomy 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

11、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 di

12、lated and has been termed the aortic spindle.2013-10-09男，30歲，突發(fā)劇烈胸痛就診主動(dòng)脈邊緣毛糙DeBakey 型，伴左腎梗死2013-10-092013-10-09男，28歲，突發(fā)劇烈胸痛就診2013-10-092013-10-09心電門控掃描，DeBakey 型，累及右側(cè)冠狀動(dòng)脈起始部斜矢狀圖像2013-10-09VR圖清晰顯示假腔范圍，并發(fā)峽部囊狀動(dòng)脈瘤2013-10-09女，49歲，降主動(dòng)脈支架置入病史2013-10-092013-10-09Debakey 型Debakey 型，左腎動(dòng)脈起源于假腔2013-10-09鑒別升主動(dòng)脈搏動(dòng)偽