呼吸系統(tǒng)放射影像學(xué)

RadiologyofRespiratorySystem1精選ppt課件AimsBasicsBestexamresultsAppreciatetheroleradiologyplays?Instillaninterestinradiology2精選ppt課件BeforeClass:TextbookReferencebookLiteratureInternetAppsTeacher&classmateHistologyandEmbryologyAnatomyPathologyInternalMedicineSurgeryGynecologyPediatricsNeurology。。。Everything。。。Uneedtoknow3精選ppt課件methodsX-rayCTMRDSAUSNuclearMedicinePET/CTRadionuclideventilationperfusionimaging4精選ppt課件X-rayTechniquesPA（posteroanterior)&LateralMoreinformationTwoviewsStandardizedDistancePtneedstobestablePortableQuickAnywhereOneshotNostandardization5精選ppt課件PAPortable6精選ppt課件Techniques-ProjectionP-A(relationofx-raybeamtopatient)7精選ppt課件Techniques-Projection(continued)A-PSupine/Erect8精選ppt課件Techniques-Projection(continued)Lateral9精選ppt課件Techniques-Projection(continued)LateralDecubitusOblique10精選ppt課件TechnicalDetailsTypeOrientationRotationInspiration/expirationPenetration11精選ppt課件Rotation12精選ppt課件Rotation(continued)13精選ppt課件Penetration14精選ppt課件Inspiration/Expiration15精選ppt課件ThingstoseeABCDE…AirwaysTrachea,endotrachealtube,etcBonesClavicles,ribs,etc…CardiacDiaphragm(Righthemidiaphragmslightlyhigher(~1.5cm)Everythingelse(tubes),effusions16精選ppt課件17精選ppt課件18精選ppt課件19精選ppt課件DensitiesThebigtwodensitiesare:(1)WHITE-Bone(2)BLACK-AirTheothersare:(3)DARKGREY-Fat(4)GREY-Softtissue/water

AndifanythingMan-madeisonthefilm,itis:(5)BRIGHTWHITE-Man-made20精選ppt課件Anatomy21精選ppt課件Anatomy22精選ppt課件BronchopulmonaryAnatomy23精選ppt課件Cross-sectionalAnatomyofLungSegments（CT）24精選ppt課件LobesRightupperlobe:25精選ppt課件Lobes(continued)Rightmiddlelobe:26精選ppt課件Lobes(continued)Rightlowerlobe:27精選ppt課件Lobes(continued)Leftlowerlobe:28精選ppt課件Lobes(continued)LeftupperlobewithLingula:29精選ppt課件Lobes(continued)Lingula:30精選ppt課件Lobes(continued)Leftupperlobe-upperdivision:31精選ppt課件HeartRightborder:Edgeof(r)Atrium3.Leftborder:(l)Ventricle+Atrium4.Posteriorborder:ReftVentricle5.Anteriorborder:RightVentricle32精選ppt課件Heart(continued。。。。)33精選ppt課件Heart

IT’SNOTMINE….34精選ppt課件HilumMadeof:1.PulmonaryArt.+Veins2.TheBronchi

LeftHilumhigher(max1-2,5cm)Identical:size,shape,density35精選ppt課件Hilum36精選ppt課件Ribs37精選ppt課件Reviewareas:ApicesBehindtheheart

Costophrenicangle(CPA)BelowthediaphragmSofttissues(breast,surgicalemphysema)Ribs&clavicleVertebrae

38精選ppt課件Abnormals39精選ppt課件LungfindingsDarkerareasradiolucentPneumothoraxCysts/bullaAirbronchogramsLighterareasOpacitiesAtelectasis“infiltrates”BloodPusWaterNodulesormass40精選ppt課件OpacitiesLobarornot….PneumoniaPulmonaryEdema“fluffy,”diffuse,“batwing”distributionHemorrhageCan’ttellbyx-ray,needbronch41精選ppt課件RMLpneumoniaOpacities42精選ppt課件RLLpneumoniaOpacities43精選ppt課件RULpneumonia44精選ppt課件LLLpneumonia45精選ppt課件ConsolidationonCT46精選ppt課件TheEnlargedHilaCauses:

1.Adenopathies(neoplasia,infection)

2.PrimaryTumor

3.Vascular

4.Sarcoidosis47精選ppt課件Mass48精選ppt課件

HilarLymphadenopathy-BL49精選ppt課件

MultipleMassesMetas50精選ppt課件PleuralEffusion51精選ppt課件PulmonaryFibrosis52精選ppt課件Heartfailure，KerleyA/Bline（Interstitiallunghyperplasiaedema）53精選ppt課件Heartfailure54精選ppt課件Pneumothorax55精選ppt課件Emphysema56精選ppt課件Cavitatinglesion57精選ppt課件Thin-walledCavitatinglesionThick-walledCavitatinglesion

3mm58精選ppt課件Bronchiectasis59精選ppt課件Miliaryshadowing60精選ppt課件CalcificationBenignPatternsofCalcificationWithinaSolitaryPulmonaryNodule61精選ppt課件ChestTube,NGTube,Pulm.arterycath62精選ppt課件CTIndications63精選ppt課件KeyClinicalFactorsGrowthPatternSizeMargin(Border)CharacteristicsDensityContrast-EnhancedCTOtherfindings64精選ppt課件PulmonaryInfection

airspaceopacificationairbronchogramsdensemultifocalsegmentalpneumonia65精選ppt課件lungabscesscavitationLobar/segmentalconsolidationPneumoniafinding66精選ppt課件TuberculosisinfiltratesMiliaryshadowingTuberculomaChronicfibro-cavitaryTB67精選ppt課件CAUSESOFSOLITARYPULMONARYNODULES（SPN）Neoplastic:Malignant

Bronchogeniccarcinoma

Solitarymetastasis

Lymphoma

Carcinoidtumor

Neoplastic:Benign

Hamartoma

Benignconnectivetissueandneuraltumors(e.g.,lipoma,fibroma,neurofibroma)

Inflammatory

Granuloma

Lungabscess

Rheumatoidnodule

Inflammatorypseudotumor(plasmacellgranuloma)

Congenital

Arteriovenousmalformation

Lungcyst

Bronchialatresiawithmucoidimpaction

Miscellaneous

Pulmonaryinfarct

Intrapulmonarylymphnode

Mucoidimpaction

Hematoma

Amyloidosis

Normalconfluenceofpulmonaryveins

MimicsofSPN

Nippleshadow

Cutaneouslesion(e.g.,wart,mole)

Ribfractureorotherbonelesionloculatedpleuraleffusion68精選ppt課件Neoplastic:BenignHamartoma69精選ppt課件Neoplastic:MalignantBronchogeniccarcinoma70精選ppt課件Neoplastic:MalignantBronchogeniccarcinoma71精選ppt課件InflammatoryGranulomachestradiographshowsasmall,well-circumscribed,roundopacityattherightlungbase(arrows).Lateralviewshowsthattheopacityiswithinthelungontwoviews(posteriorsegmentoftherightlowerlobe)andthusrepresentsapulmonarynodule(arrow).72精選ppt課件ContrastCTinMalignantSolitaryPulmonaryNodule.Thin-collimation(3-mm)CTscansthroughleftupperlobenoduleina62-year-oldwomanwithbiopsy-provenlungcancershowsalobulatedcontourwithpositiveenhancementof50HaftercontrastadministrationMalignantSPN73精選ppt課件BronchogenicCarcinoma（Clinical）Ageatdiagnosis:55-60years(range40-80years);M:F=1.4:1asymptomatic(10-50%)usuallywithperipheraltumorssymptomsofcentraltumors:cough(75%),wheezing,pneumoniahemoptysis(50%),dysphagia(2%)symptomsofperipheraltumors:pleuritic/localchestpain,dyspnea,coughPancoastsyndrome,superiorvenacavasyndromehoarsenesssymptomsofmetastaticdisease(CNS,bone,liver,adrenalgland)paraneoplasticsyndromes:cachexiaofmalignancyclubbing+hypertrophicosteoarthropathynonbacterialthromboticendocarditismigratorythrombophlebitisectopichormoneproduction:hypercalcemia,syndromeofinappropriatesecretionofantidiuretichormone,Cushingsyndrome,gynecomastia,acromegaly74精選ppt課件RiskfactorsCigarettesmoking(squamouscellcarcinoma+smallcellcarcinoma)鈥搑elatedtonumberofcigarettessmoked,depthofinhalation,ageatwhichsmokingbegan85%oflungcancerdeathsareattributabletocigarettesmoking!Passivesmokingmayaccountfor25%oflungcancersinnonsmokers!Radongas:maybethe2ndleadingcauseforlungcancerwithupto20,000deathsperyearIndustrialexposure:asbestos,uranium,arsenic,chlormethyletherConcomitantdisease:chronicpulmonaryscar+pulmonaryfibrosisScarcarcinoma45%ofallperipheralcancersoriginateinscars!Incidence:7%oflungtumors;1%ofautopsiesOrigin:relatedtoinfarcts(>50%),tuberculosisscar(<25%)Histo:adenocarcinoma(72%),squamouscellcarcinoma(18%)

Location:upperlobes(75%)75精選ppt課件Types:Adenocarcinoma(50%)Mostcommoncelltypeseeninwomen+nonsmokersIntermediatemalignantpotential(slowgrowth,highincidenceofearlymetastases)almostinvariablydevelopsinperiphery;frequentlyfoundinscars(tuberculosis,infarction,scleroderma,bronchiectasis)+incloserelationtopreexistingbullaesolitaryperipheralsubpleuralmass(52%)/alveolarinfiltrate/multiplenodulesmayinvadepleura+growcircumferentiallyaroundlungmimickingmalignantmesotheliomaupperlobedistribution(69%)airbroncho-/bronchiologramonHRCT(65%)calcificationinperipheryofmass(1%)smoothmargin/spiculatedmarginduetodesmoplasticreactionwithretractionofpleura76精選ppt課件AdenocarcinomaPresentingasSolitaryPulmonaryNodule.Cone-downviewofposteroanteriorradiographshowsnoduleintherightmid-lung(arrow).Thin-sectionCTshows12-mmnodulewithspiculatedmargins(arrow)inthesuperiorsegmentoftherightlowerlobe.Transthoracicneedlebiopsyrevealedadenocarcinoma.solitaryperipheralmass77精選ppt課件Squamouscellcarcinoma(30-35%)StronglyassociatedwithcigarettesmokingCentrallocationwithinmain/lobar/segmentalbronchus(2/3)largecentralmass

&cavitationdistalatelectasis&

bulgingfissure(duetomass)postobstructivepneumoniaAllcasesofpneumoniainadultsshouldbefollowedtocompleteradiologicresolution!airwayobstructionwithatelectasis(37%)Solitaryperipheralnodule(1/3)characteristiccavitation(in7-10%)Squamouscellcarcinomaisthemostcommoncelltypetocavitate!invasionofchestwallSquamouscellcarcinomaisthemostcommoncelltypetocausePancoasttumor78精選ppt課件CentrallungcancerSquamousCellCarcinoma.Posteroanteriorchestfilmina58-year-oldmalesmokerwithhemoptysisshowsalefthilarmasswithleftupperlobeatelectasis.EnhancedCTscanshowsthelefthilarmassoccludingtheleftupperlobebronchuswithanendobronchialcomponent(straightarrow).Notethepresenceofmucusbronchogramswithintheatelectaticlung(curvedarrow)79精選ppt課件SquamousCellCarcinoma80精選ppt課件Smallcellundifferentiatedcarcinoma(15%)StronglyassociatedwithcigarettesmokingRapidgrowth+highmetastaticpotentialtypicallylargehilar/perihilarmassoftenassociatedwithmediastinalwidening(fromadenop