循環(huán)系統(tǒng)專業(yè)知識講座

循環(huán)系統(tǒng)

Circulatorysystem程克斌KebinCheng內容檢驗措施旳選擇正常心臟三位片及徑線測量閱片順序常見心臟病和肺血管變化旳影像體現(xiàn)檢驗措施旳選擇透視平片MSCTMRI超聲心動圖英文縮寫PA位（Posterior-anteriorview)后前位RAO(rightanteriorobliqueview)右前斜位LAO(leftanteriorobliqueview)左前斜位LA(leftatrium）左房LV（leftventricle）左室RA(rightatrium）右房RV(rightventricle）右室LR膠片球管2米橫位心斜位心垂位心小兒球形心AscendingAorta“Doubledensity”ofLAenlargementRightatriumLeftventricleIndentationforLApulmonaryarterialsegementAorticknobTheCardiacContours

SuperiorvenacavaInferiorvenacavaRAOviewLARAAscendingaortaPulmonaryarteriousconeRVLAOAscendingaortaRVLVLMBRALAEnlargementofheartchambersandgreatvesselsLAenlargementMainPulmonaryArteryBIGLVenlargementRVenlargementRAenlargementLeftatriumsitsinmiddleofheartposteriorlyLeftatriumformsnoborderofnormalheartinPAviewLARALVNomalleftatrium“DoubleDensity”

ofleftatrialenlargementWhentheLAenlargesStraightenedleftheartborderLeftatrialenlargementLA,RV,LVenlargement.MPAbig=mitralvalvestenosis+mitralvalveincompetenceRAOLAOPAStraightenedleftheartborderImportantMainPulmonaryArtery

AdjacenttoleftpulmonaryarteryFindingtheMainPulmonaryArtery

Wecanmeasurethemainpulmonaryartery...Ifwedrawatangentlinefromtheapexoftheleftventricletotheaorticknob(redline)andmeasurealongaperpendiculartothattangentline(yellowline)Thedistancebetweenthetangentandthemainpulmonaryartery(betweentwosmallgreenarrows)fallsinarangebetween0mm(touchingthetangentline)toasmuchas15mmawayfromthetangentline0mmMain

Pulmonary

ArteryAo15mmMain

Pulmonary

ArteryAoLVLVMainpulmonary

arteryrangesfrom

0mm–15mm

fromtangentlineTwoMajorClassificationsThemainpulmonaryartery(MPA)projectsbeyondthetangentlineThemainpulmonaryarteryismorethan15mmawayfromthetangentlineIncreasedpressureIncreasedflowMainpulmonaryarteryprojectsbeyondtangent

27SmallpulmonaryarteryTetralogyofFallotMainpulmonaryarteryismorethan15mm

fromtangent靴形心Leftventricleand/oraorticknobpushthetangentawayCommon29Mainpulmonaryarteryismorethan15mm

fromtangent主動脈型心臟??Aorticknobshouldmeasure

<35mmAorticKnob

Thefirstbumpontheleft-sideistheaorticarch.Wecanmeasuretheknobfromthelateralborderofairinthetracheatotheedgeoftheaorticknob.42mmEnlargedwith:IncreasedpressureIncreasedflowChangesinaorticwallAorticKnob

LeftVentricleNormalleftventricle

?Cardio-thoracicRatio<50%Leftventricleenlargement主動脈型心臟LeftatrialenlargementLA,RV,LVenlargement.MPAbig=mitralvalvestenosis+mitralvalveincompetenceRAOLAOPAStraightenedleftheartborderRVenlargement二尖瓣型心RVenlargementPALAORAOLA,RV,LV

enlargement.MPAbig=mitralvalvestenosis+mitralvalveincompetenceWhichVentricleisEnlarged?IfHeartIsEnlarged,

AndMainPulmonaryArteryisBig>50%WhichVentricleisEnlarged?ThenRightVentricleisEnlargedIfHeartIsEnlarged,

AndAortaisBig>50%WhichVentricleisEnlarged?ThenLeftVentricleisEnlargedLowdensity,

almoststraightedge

representssize

ofascendingaortaAscendingAortaSmallProminentAscendingAortaRightatrium–notimportantcontourinadultsRightatriumRightatriumenlargementRA,RVenlargement,pulmonaryarterialhypertensionAtrialseptaldefectThePulmonary

VasculatureFiveStatesofthePulmonaryVasculatureNormalPulmonaryvenoushypertensionPulmonaryarterialhypertensionIncreasedflowDecreasedflowWhatWe’reGoingtoEvaluateRightDescendingPulmonaryArteryDistributionofflowinthelungsUpperversuslowerlobesCentralversusperipheralRightDescendingPulmonaryArteryServesrightmiddleandlowerlobes1.RightDescendingPulmonaryArteryDiametercanbemeasured(beforebifurcation)RDPA

<15mm1.RightDescendingPulmonaryArteryNormally,therightdescendingpulmonaryarteryshouldnotbemorethan15mmindiameter2.NormalDistributionofFlow

UpperVersusLowerLobesInerectposition,bloodflowtobases>thanflowtoapicesSizeofvesselsatbasesisnormally

>thansize

ofvessels

atapexYoucan’tmeasuresizeofvesselsattheleftbasebecausetheheartobscuresthemNormaltaperingofvesselsfromcentraltoperipheralCentralvesselsgiverisetoprogressivelysmallerperipheralbranches3.NormalDistributionofFlow

Centralversusperipheral1322NormalVasculature-reviewRDPA

<15mmindiameterLowerlobevesselslargerthanupperlobevesselsGradualtaperingofvesselsfromcentraltoperipheralRDPAusually

>15mmUpperlobevesselsequaltoorlargerthansizeoflowerlobevesselsVenousHypertensionVenousHypertensionPulmonaryvenousstasisMitralvalvestenosisPulmonaryedemaMitralvalvestenosisRheumaticheartdisease，LA,RA,RVenlargement，hemosiderin肺淤血－含鐵血黃素從容二狹－LA,RV輕度增大PARAOLAOPulmonaryArterialHypertensionRDPAusually

>15mmMainPulmonaryArteryprojectsbeyondtangentlineRapidcutoffinsizeofperipheralvesselsrelativetosizeofcentralvesselsIncreasedFlowRDPAusually

>15mmUnrecognizablemostofthetimeSmallhilaFewerthannormalbloodvesselsDecreasedFlowTetralogyofFallot怎樣對心臟片進行診療

TheABC,SCardiacevaluationRemember:cardiothoracicratioofabout0.5appliesonlytogoodPAchest