循环系统专业知识讲座专家讲座

循环系统

Circulatorysystem程克斌KebinCheng循环系统专业知识讲座第1页内容检验方法选择正常心脏三位片及径线测量阅片次序常见心脏病和肺血管改变影像表现循环系统专业知识讲座第2页检验方法选择透视平片MSCTMRI超声心动图循环系统专业知识讲座第3页循环系统专业知识讲座第4页英文缩写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）右室循环系统专业知识讲座第5页LR胶片球管2米循环系统专业知识讲座第6页横位心斜位心垂位心小儿球形心循环系统专业知识讲座第7页AscendingAorta“Doubledensity”ofLAenlargementRightatriumLeftventricleIndentationforLApulmonaryarterialsegementAorticknobTheCardiacContours

SuperiorvenacavaInferiorvenacava循环系统专业知识讲座第8页RAOviewLARAAscendingaortaPulmonaryarteriousconeRV循环系统专业知识讲座第9页LAOAscendingaortaRVLVLMBRALA循环系统专业知识讲座第10页EnlargementofheartchambersandgreatvesselsLAenlargementMainPulmonaryArteryBIGLVenlargementRVenlargementRAenlargement循环系统专业知识讲座第11页LeftatriumsitsinmiddleofheartposteriorlyLeftatriumformsnoborderofnormalheartinPAviewLARALVNomalleftatrium循环系统专业知识讲座第12页“DoubleDensity”

ofleftatrialenlargementWhentheLAenlargesStraightenedleftheartborder循环系统专业知识讲座第13页LeftatrialenlargementLA,RV,LVenlargement.MPAbig=mitralvalvestenosis+mitralvalveincompetenceRAOLAOPAStraightenedleftheartborder循环系统专业知识讲座第14页ImportantMainPulmonaryArtery

循环系统专业知识讲座第15页AdjacenttoleftpulmonaryarteryFindingtheMainPulmonaryArtery

Wecanmeasurethemainpulmonaryartery...循环系统专业知识讲座第16页Ifwedrawatangentlinefromtheapexoftheleftventricletotheaorticknob(redline)andmeasurealongaperpendiculartothattangentline(yellowline)Thedistancebetweenthetangentandthemainpulmonaryartery(betweentwosmallgreenarrows)fallsinarangebetween0mm(touchingthetangentline)toasmuchas15mmawayfromthetangentline循环系统专业知识讲座第17页0mmMain

Pulmonary

ArteryAo15mmMain

Pulmonary

ArteryAoLVLVMainpulmonary

arteryrangesfrom

0mm–15mm

fromtangentline循环系统专业知识讲座第18页TwoMajorClassificationsThemainpulmonaryartery(MPA)projectsbeyondthetangentlineThemainpulmonaryarteryismorethan15mmawayfromthetangentline循环系统专业知识讲座第19页IncreasedpressureIncreasedflowMainpulmonaryarteryprojectsbeyondtangent

循环系统专业知识讲座第20页27SmallpulmonaryarteryTetralogyofFallotMainpulmonaryarteryismorethan15mm

fromtangent靴形心循环系统专业知识讲座第21页Leftventricleand/oraorticknobpushthetangentawayCommon29Mainpulmonaryarteryismorethan15mm

fromtangent主动脉型心脏??循环系统专业知识讲座第22页Aorticknobshouldmeasure

<35mmAorticKnob

Thefirstbumpontheleft-sideistheaorticarch.Wecanmeasuretheknobfromthelateralborderofairinthetracheatotheedgeoftheaorticknob.循环系统专业知识讲座第23页42mmEnlargedwith:IncreasedpressureIncreasedflowChangesinaorticwallAorticKnob

循环系统专业知识讲座第24页LeftVentricleNormalleftventricle

?循环系统专业知识讲座第25页Cardio-thoracicRatio<50%循环系统专业知识讲座第26页Leftventricleenlargement主动脉型心脏循环系统专业知识讲座第27页LeftatrialenlargementLA,RV,LVenlargement.MPAbig=mitralvalvestenosis+mitralvalveincompetenceRAOLAOPAStraightenedleftheartborder循环系统专业知识讲座第28页RVenlargement二尖瓣型心循环系统专业知识讲座第29页RVenlargementPALAORAOLA,RV,LV

enlargement.MPAbig=mitralvalvestenosis+mitralvalveincompetence循环系统专业知识讲座第30页WhichVentricleisEnlarged?循环系统专业知识讲座第31页IfHeartIsEnlarged,

AndMainPulmonaryArteryisBig>50%WhichVentricleisEnlarged?ThenRightVentricleisEnlarged循环系统专业知识讲座第32页IfHeartIsEnlarged,

AndAortaisBig>50%WhichVentricleisEnlarged?ThenLeftVentricleisEnlarged循环系统专业知识讲座第33页Lowdensity,

almoststraightedge

representssize

ofascendingaortaAscendingAorta循环系统专业知识讲座第34页SmallProminentAscendingAorta循环系统专业知识讲座第35页Rightatrium–notimportantcontourinadultsRightatrium循环系统专业知识讲座第36页RightatriumenlargementRA,RVenlargement,pulmonaryarterialhypertensionAtrialseptaldefect循环系统专业知识讲座第37页ThePulmonary

Vasculature循环系统专业知识讲座第38页FiveStatesofthePulmonaryVasculatureNormalPulmonaryvenoushypertensionPulmonaryarterialhypertensionIncreasedflowDecreasedflow循环系统专业知识讲座第39页WhatWe’reGoingtoEvaluateRightDescendingPulmonaryArteryDistributionofflowinthelungsUpperversuslowerlobesCentralversusperipheral循环系统专业知识讲座第40页RightDescendingPulmonaryArteryServesrightmiddleandlowerlobes1.RightDescendingPulmonaryArtery循环系统专业知识讲座第41页Diametercanbemeasured(beforebifurcation)RDPA

<15mm1.RightDescendingPulmonaryArteryNormally,therightdescendingpulmonaryarteryshouldnotbemorethan15mmindiameter循环系统专业知识讲座第42页2.NormalDistributionofFlow

UpperVersusLowerLobesInerectposition,bloodflowtobases>thanflowtoapicesSizeofvesselsatbasesisnormally

>thansize

ofvessels

atapexYoucan’tmeasuresizeofvesselsattheleftbasebecausetheheartobscuresthem循环系统专业知识讲座第43页NormaltaperingofvesselsfromcentraltoperipheralCentralvesselsgiverisetoprogressivelysmallerperipheralbranches3.NormalDistributionofFlow

Centralversusperipheral循环系统专业知识讲座第44页1322NormalVasculature-reviewRDPA

<15mmindiameterLowerlobevesselslargerthanupperlobevesselsGradualtaperingofvesselsfromcentraltoperipheral循环系统专业知识讲座第45页RDPAusually

>15mmUpperlobevesselsequaltoorlargerthansizeoflowerlobevesselsVenousHypertension循环系统专业知识讲座第46页VenousHypertensionPulmonaryvenousstasisMitralvalvestenosisPulmonaryedemaMitralvalvestenosis循环系统专业知识讲座第47页Rheumaticheartdisease，LA,RA,RVenlargement，hemosiderin循环系统专业知识讲座第48页肺淤血－含铁血黄素从容二狭－LA,RV轻度增大PARAOLAO循环系统专业知识讲座第49页PulmonaryArterialHypertensionRDPAusually

>15mmMainPulmonaryArteryprojectsbeyondtangentlineRapidcutoffinsizeofperipheralvesselsrelativetosizeofcentralvessels循环系统专业知识讲座第50页IncreasedFlowRDPAusually

>15mm循环系统专业知识讲座第5