胸部正常CT斷層解剖圖片

1、胸部正常CT斷層解剖圖片目 錄概論縱隔窗的CT解剖肺窗的CT解剖 前 言 肺、縱隔內(nèi)部組織結(jié)構(gòu)之間、正常結(jié)構(gòu)與病變之間的密度差異 CT滿(mǎn)意顯示胸部正常結(jié)構(gòu)和病灶的大體解剖，定位、定量準(zhǔn)確，為定性分析提供形態(tài)學(xué)基礎(chǔ)有關(guān)胸部CT檢查技術(shù)的幾個(gè)問(wèn)題1、CT值與窗寬、窗位：肺窗和縱膈窗，雙 窗技術(shù)2、層厚和層距：吸氣末掃描，薄層/重疊掃 描；減小部分容積效應(yīng)、肺血墜積現(xiàn)象3、平掃和增強(qiáng)掃描：LN，病灶，血管4、高分辨CT（High Resolution ,HRCT） 層厚 12mm，顯示次級(jí)肺小葉結(jié)構(gòu)； 顯示間質(zhì)性病變、支擴(kuò)、孤立小病灶 胸部正常CT解剖縱隔窗 一、 主要觀察內(nèi)容 1、縱膈：有無(wú)縱膈腫

2、塊、多余結(jié)構(gòu) LN有無(wú)腫大或/及增多 “三管”結(jié)構(gòu)形態(tài)（氣道結(jié)合肺窗） 2、較大范圍的肺、胸膜（腔）病變的內(nèi)部 結(jié)構(gòu) 3、閱片順序： 辨認(rèn)每一層縱膈內(nèi)的“三管”結(jié)構(gòu) 自上而下、由近段向遠(yuǎn)段 完整觀察某一結(jié)構(gòu)主要層面和結(jié)構(gòu)主動(dòng)脈弓及其以上層面：辨認(rèn)頭臂血管主-肺動(dòng)脈窗層面：窗空虛/潛在，氣管分叉，奇V弓右上葉支氣管層面：左PA弓、右上PV前干，右上PA，上腔V左上葉支氣管層面：右中間段支氣管，右PA，右下PA，左上PV，左PA降支其他肺門(mén)層面：兩側(cè)大小基本對(duì)稱(chēng)（肺窗顯示更佳），相伴隨的支氣管和PA分支，由近向遠(yuǎn)漸小Can you find the right and left subclavia

3、n arteries? (click for answer)The right subclavian artery as itdumps into the brachiocephalic artery.(click to highlight)What are the 3 yellow air-filled (black) structures highlighted here? (click to highlight)These are the Right lung apexTrachea and Esophagus.This is contrast (white) being injecte

4、d into the left subclavian vein.Can you find the first 3 branches off the aortic arch? (click for answer)Brachiocephalic arteryLeft Common Carotid arteryLeft Subclavian arteryIncidental lipoma (fat tumor) (notice it is the same density as fat in the chest wall) Can you find the left brachiocephalic

5、vein as it dumps into the SVC?(click for answer)We are at the level of the top of the aortic arch (click to highlight)Can you find the right pectoralis major and minor? (click for answer)What is the structure in blue? (click to highlight)This is the SuperiorVena cavaCan you find the azygous arch ? (

6、where the azygous vein comes across to dump into the SVC) (click for answer)Notice the bifurcation ofthe trachea (corina) at this level (click to highlight)What is the structure in red? (click to highlight)This is the left pulmonaryartery.Can you find the pulmonary trunk and right pulmonary artery?

7、(click for answer)Where are the ascending (A) and descending (D) limbs of the thoracic aorta? (click to highlight)ADWe are at the level of the top of the left atrium. Notice The pulmonary veins dumping into it as they return from the lungs. (click to highlight)Can you find the left main coronary art

8、ery coming off the aorta? (click for answer)You can further seeThe left coronary branch into theCircumflex artery and theLAD artery (click to highlight)Here is a good image of the aortic semi-lunar valve leaflets. Can you find them? (click for answer)Here is a good image of the left atrium dumping I

9、nto the left ventricle. Can you find it? (click to highlight)You can clearly see the left ventricular wall and septum with the projecting papillary wall muscles attachingto the mitral valve leaflets. (click to highlight)Contrast filling the right ventricleCan you find the pericardial sac here? (clic

10、k for answer)It is relatively easy tosee because there is a fat layer around the heartand around the pericardium making the soft tissue more visible縱膈的分區(qū)方法：CT較平片 （側(cè)位）直接顯示 前縱膈 - 心臟、大血管前 間隙，胸腺中縱膈 - “三管”結(jié)構(gòu)及其 周?chē)g隙、LN后縱膈 - 脊柱旁（溝）； 脊神經(jīng)、植物神經(jīng) 心臟和心包 胸部正常CT解剖肺窗一、主要觀察內(nèi)容 1、CT肺門(mén)（肺野內(nèi)帶）：第一、二肺門(mén)之間的血 管、支氣管等 內(nèi)側(cè) - 與縱膈內(nèi)

11、支氣管、血管相續(xù)（結(jié)合縱膈窗） 外側(cè) - 段支氣管開(kāi)口處，與外周支氣管血管束相續(xù) 2、支氣管血管束（肺野中帶） 由肺門(mén)發(fā)出的、相伴行的支氣管和肺A分支； 向肺門(mén)/左房回流的、無(wú)支氣管伴行的肺靜脈 3、外周肺（胸膜下區(qū)）：段以下的血管、支氣管斷面 影，呈小條、星、叉、點(diǎn)狀 4、閱片要點(diǎn)：抓住重點(diǎn)層面， 觀察每一層時(shí)，注意上下相鄰層面， 完整觀察某一結(jié)構(gòu)二、主要層面和結(jié)構(gòu) 標(biāo)志：與肺門(mén)相續(xù)的支氣管、血管 1、右上葉支氣管以上層面： 兩側(cè)尖段支氣管及其外側(cè)的同名動(dòng)脈 2、右上葉支氣管層面：右主支氣管，前、后段支氣管， 右PA上干；右上PV前干 左上前段支氣管 3、右中間段支氣管層面：葉間動(dòng)脈（右下PA