胸部正常CT解剖.ppt

胸部正常CT解剖,长沙医学院:吴龙,目录,概论纵隔窗的CT解剖肺窗的CT解剖,前言肺、纵隔内部组织结构之间、正常结构与病变之间的密度差异CT满意显示胸部正常结构和病灶的大体解剖，定位、定量准确，为定性分析提供形态学基础,有关胸部CT检查技术的几个问题1、CT值与窗宽、窗位：肺窗和纵膈窗，双窗技术2、层厚和层距：吸气末扫描，薄层/重叠扫描；减小部分容积效应、肺血坠积现象3、平扫和增强扫描：LN，病灶，血管4、高分辨CT（HighResolution,HRCT）层厚12mm，显示次级肺小叶结构；显示间质性病变、支扩、孤立小病灶,胸部正常CT解剖,纵隔窗,一、主要观察内容1、纵膈：有无纵膈肿块、多余结构LN有无肿大或/及增多“三管”结构形态（气道结合肺窗）2、较大范围的肺、胸膜（腔）病变的内部结构3、阅片顺序：辨认每一层纵膈内的“三管”结构自上而下、由近段向远段完整观察某一结构,主要层面和结构,主动脉弓及其以上层面：辨认头臂血管主-肺动脉窗层面：窗空虚/潜在，气管分叉，奇V弓右上叶支气管层面：左PA弓、右上PV前干，右上PA，上腔V左上叶支气管层面：右中间段支气管，右PA，右下PA，左上PV，左PA降支其他肺门层面：两侧大小基本对称（肺窗显示更佳），相伴随的支气管和PA分支，由近向远渐小,Canyoufindtherightandleftsubclavianarteries?(clickforanswer),Therightsubclavianarteryasitdumpsintothebrachiocephalicartery.(clicktohighlight),Whatarethe3yellowair-filled(black)structureshighlightedhere?(clicktohighlight),Thisiscontrast(white)beinginjectedintotheleftsubclavianvein.,Canyoufindthefirst3branchesofftheaorticarch?(clickforanswer),Incidentallipoma(fattumor)(noticeitisthesamedensityasfatinthechestwall),CanyoufindtheleftbrachiocephalicveinasitdumpsintotheSVC?(clickforanswer),Weareatthelevelofthetopoftheaorticarch(clicktohighlight),Canyoufindtherightpectoralismajorandminor?(clickforanswer),Whatisthestructureinblue?(clicktohighlight),ThisistheSuperiorVenacava,Canyoufindtheazygousarch?(wheretheazygousveincomesacrosstodumpintotheSVC)(clickforanswer),Noticethebifurcationofthetrachea(corina)atthislevel(clicktohighlight),Whatisthestructureinred?(clicktohighlight),Thisistheleftpulmonaryartery.,Canyoufindthepulmonarytrunkandrightpulmonaryartery?(clickforanswer),Wherearetheascending(A)anddescending(D)limbsofthethoracicaorta?(clicktohighlight),Weareatthelevelofthetopoftheleftatrium.NoticeThepulmonaryveinsdumpingintoitastheyreturnfromthelungs.(clicktohighlight),Canyoufindtheleftmaincoronaryarterycomingofftheaorta?(clickforanswer),YoucanfurtherseeTheleftcoronarybranchintotheCircumflexarteryandtheLADartery(clicktohighlight),Hereisagoodimageoftheaorticsemi-lunarvalveleaflets.Canyoufindthem?(clickforanswer),HereisagoodimageoftheleftatriumdumpingIntotheleftventricle.Canyoufindit?(clicktohighlight),Youcanclearlyseetheleftventricularwallandseptumwiththeprojectingpapillarywallmusclesattachingtothemitralvalveleaflets.(clicktohighlight),Contrastfillingtherightventricle,Canyoufindthepericardialsachere?(clickforanswer),Itisrelativelyeasytoseebecausethereisafatlayeraroundtheheartandaroundthepericardiummakingthesofttissuemorevisible,纵膈的分区方法：CT较平片（侧位）直接显示前纵膈-心脏、大血管前间隙，胸腺中纵膈-“三管”结构及其周围间隙、LN后纵膈-脊柱旁（沟）；脊神经、植物神经心脏和心包,胸部正常CT解剖,肺窗,一、主要观察内容1、CT肺门（肺野内带）：第一、二肺门之间的血管、支气管等内侧-与纵膈内支气管、血管相续（结合纵膈窗）外侧-段支气管开口处，与外周支气管血管束相续2、支气管血管束（肺野中带）由肺门发出的、相伴行的支气管和肺A分支；向肺门/左房回流的、无支气管伴行的肺静脉3、外周肺（胸膜下区）：段以下的血管、支气管断面影，呈小条、星、叉、点状4、阅片要点：抓住重点层面，观察每一层时，注意上下相邻层面，完整观察某一结构,二、主要层面和结构标志：与肺门相续的支气管、血管1、右上叶支气管以上层面：两侧尖段支气管及其外侧的同名动脉2、右上叶支气管层面：右主支气管，前、后段支气管，右PA上干；右上PV前干左上前段支气管3、右中间段支气管层面：叶间动脉（右下PA