循環(huán)系統(tǒng)X線診斷-英文課件

1、Radiodiagnosis in the Circulatory System循環(huán)系統(tǒng)X線診斷貴州省人民醫(yī)院放射科 唐雷Section 1 The Heart1. Types of Heart in the Plain Films In the normal condition, a heart often appears in the horizontal（橫型）, oblique（斜型）, and pendulous（懸垂型） type respectively on a posteroanterior radiograph of the heart.The angle of the c

2、ardiac axis（心軸角） : it is an acute angle formed by a line from the conjunction of the great vessules of the right cardiac border and the right atrium（心房） to the cardiac apex（心尖） and a horizontal line which passes through the cardiac apex.心軸角：右心緣大血管與右房交界點(diǎn)至心尖的連線，與水平線的夾角。The horizontal type （橫型） 45 ( 52

3、 55)Three types of the heart in the plain filmA type of the heart can derive from several heart diseases. For example,The mitral type of the heart may originate from pulmonary heart diseases, rheumatic heart diseases, congenital heart diseases of shunt from left to right.The aortic type of the heart

4、 may come from hypertensive heart diseases, rheumatic heart diseases (involing aortic valves), congenital heart diseases, cardiomyopathy.The general enlarged type of the heart may come from cardiomyopathy, pericardial effusion. 2. Different routine projections of the cardiac atria and ventricles PA:

5、 posteroanterior radiograph（后前位）LL: left lateral radiograph（左側(cè)位）RAO: right anterior oblique radiograph（右前斜位）LAO: left anterior oblique radiograph（左前斜位）LL: left lateral radiograph（左側(cè)位）RAO: right anterior oblique radiograph（右前斜位）cardiac atria are distinguished from cardiac ventricles. Two cardiac atri

6、a locate in the posterior superior part of the heart and two cardiac ventricles overlap and settle down in the anterior inferior part of the heart.LAO: left anterior oblique radiograph（左前斜位）the shadow of the heart is divided into two halves of the right heart and left one. The right one stays in the

7、 front and the left one rests on the back.Relation between size of the heart and thecardiothracic ratio:Normal heart less than 0.52Slight enlargement 0.52 0.55Moderate enlargement 0.56 0.60Severe enlargement more than 0.604. Changes of pulmonary blood Pulmonary arterial pleonaemia (肺充血)：means that p

8、ulmonary arteries have been broadened in all its trunks and branches. Pulmonary venous pleonaemia (肺淤血)：refers to the situation that excessive blood stagnates in the pulmonary veins. So, the lung fields have an attenuated radiolucency and seem like ground glass.Cases in the HeartCase 1. 正常心臟三位片The t

9、horacic cage remains symmetrical. All the seen bones are nothing remarkable. The trachea locates centrally without deviation. The lungs are clear, while the lung markings are natural and regular. Both pulmonary hila show neither enlargement nor decrease. The heart and great vessels appear normal in

10、their position, size and shape. The cardiothoracic ratio is 0.48, and all the shadows of the arches show naturally in the margins of the heart.The diaphragm has a smooth surface with sharp costophrenic angles.On the LL radiograph, the spaces exist in the precardiac and retrocardiac clearances. There

11、 is no significant change in the shadows of the arches of the heart.On the RAO radiograph, all the shadows of the arches appear clear and nature in the heart. There is no compressive displacement in the esophagus. Nothing is remarkable in the precardiac and retrocardiac apaces.Diagnosis: Normal in t

12、he lungs, heart, and diaphragm.Case 1. 正常心臟三位片Case 2. 風(fēng)濕性心臟病The lung fields have an attenuated radiolucency. The lung markings exhibit thickenings and distortions with blurred edges and seem like ground glass. Both pulmonary hila are enlarged, and the diameter of the right inferior artery （右下肺動(dòng)脈）tot

13、als 1.8 cm with the sign of residual root（殘根征）.The heart appears in the mitral type（二尖瓣型）. The shadow of the heart extends on both sides in the cardiothroacic ratio of 0.65. There are 4 arches in the left margin（四弧征）, while dual bows（雙房影） in the right margin of the heart. The angle is almost 90betwe

14、en the two main bronchi.On the LL radiograph, the clearances are closed in both precardiac and retrocardiac spaces due to enlargement of the heart. The enlarged left atrium compresses the esophagus to form an indentation.On the RAO view, the precardiac and retrocardiac spaces are enclosed. The enlar

15、ged heart pushes the esophagus backward, forming an arch indentation in the esophagus and overlaps with the spinal column. Meanwhile, the segment of the pulmonary artery bulges significantly. Diagnosis: Rheumatic heart disease. Further examination is needed by heart Doppler ultrasound.Case 2. 風(fēng)濕性心臟病

16、Case 3.室間隔缺損（VSD）The lung markings become enriched and thickened. Both pulmonary hila are enlarged. The cardiac shadow has moderate enlarged with the cardiothoracic ratio of 0.60. The aortic knob(主動(dòng)脈結(jié)) is not enlarged. The segment of the pulmonary artery (肺動(dòng)脈段) sinks and the cardiac apex becomes rou

17、nd and obtuse.On LL and RAO, the spaces have been decreased in both precardiac and retrocardiac clearances, associated with slight compressive displacement of the esophagus to the back. But the triangle clearance of the retrocardiac space still exists. Diagnosis: Ventricular septal defect is conside

18、red. Case 5. 法洛四聯(lián)癥 (tetralogy of Fallot)The lungs show hyperradiolucency with attenuated pulmonary blood vessels. Both pulmonary hila are decreased. There are areas of scattered dot-like and patchy inhomogenous opacities with hazy margins in the right upper field. The shadow of the heart looks in th

19、e aortic type (主動(dòng)脈型) with the cardiothoracic ratio of 0.64. The aortic arch (主動(dòng)脈弓) is broadened. The cardiac waist （心腰）shows a depression. The apex of the heart appears round and upturned. On the left lateral rasiograph, the anterior margin of the heart bulges obviously, but the segment of the pulmo

20、nary artery sinks. The posterior margin of the heart extends to the back and occupies a part of the retrocardiac space.Diagnosis: 1. A congenital heart disease with oligemic pulmonary blood volume is considered, and most probably, tetralogy of Fallot. Further examination is necessary , such as Doppl

21、er or MRI.2. Pneumonia is considered in the right upper field. Reexamination is suggested after treatment.Case 5. 法洛四聯(lián)癥 (tetralogy of Fallot)心包壁層心包臟層心 房心 室心包積液1、The normal state There is almost 50 ml of transparent yellowish serous fluid in the pericardiac space. The thickness ranges 1.0 2.0 mm in t

22、he parietal pericardium, which can not be seen in X-ray radiographs. 2、X-ray findingsWhen pericardial effusion is less than 300 ml，it is difficult to find with X-ray examination because the fluid remains in the recess of the pericardium.If it is over 300 ml, the shadow of the pericardium shows enlargement and extends to both sides on condition of no pericardial adhesion. The normal arches of the heart will fade out in this instan