[HU Bing] respiratory system 1.ppt

1、Medical ImagingRespiratory System,胡冰 HU Bing Department of Radiology The Third Affiliated Hospital of Sun Yat-Sen University Guangzhou, Guangdong, 510630, China,Respiratory System,Examination technology,Normal X-ray anatomy,Basic X-ray changes,Diagnosis of disease,P50-67,I. Examination technology,Fl

2、uoroscopy,Fluoroscopy,Living image Easy to use Cheap Get result at the same time Interventional operation,Low resolution High radiation dosage,Plain film radiography Chest X-ray (CXR),Frontal view,Lateral view,Chest X-ray CXR,Clear image Low radiation dosage Film,Immobile Expensive than fluoroscpy N

3、eed a long time to get result,Tomography,High KV radiography,120kv、5-7mAs,Bronchography,Angiography,CT,Lung window WW：10002000 WL：-500-800,Mediastinum window WW：300500 WL：3050,Unenhanced and enhanced CT,GE 1.5T MR,II. Normal X-ray anatomy,Normal chest X-ray anatomy,1 Chest cavity 2 Lung 3 Mediastinu

4、m 4 Diaphragm,1 Chest cavity,Soft tissue Sternocleidomastoid muscle Skin reflection over the clavicle Pectoral major muscle Female breast and nipple Bone Ribs Scapula Clavicle Sternum Thorax vertebra Pleura,Sternocleidomastoid muscle Top area of CXR Neck Vertical shadow Clear lateral margin Skin ref

5、lection over the clavicle Over the clavicle Horizontal shadow Parallel to the clavicle Fold of the skin,Female breast and nipple,Bone 12 pairs of ribs Inner side of scapula,First costal cartilage calcification,Cervical rib,Bifurcation of rib,Pleura horizontal fissure,Oblique fissure,Diaphragm 2-3cm

6、behind the sternum,T4/5,2 Lung,Lung field Hilum Lung markings Lobe, lobular Trachea, bronchi Parenchyma, interstitium,2.1 Lung fields,2.2 Hilum,Pulmonary artery Bronchi Pulmonary veins Location Middle field, inner band Left is 1-2 cm higher than right,Hilum,Hilum lateral view,Hilar enlargement,Enlar

7、ged pulmonary artery Enlargement of lymph nodes Tumors,Pulmonary artery From hilum to fields From thick to thin Like tree branch,2.3 Lung markings,2.4 Lobe: L2, R3,Segments,2.5 trachea, bronchi,Bifurcation of trachea T56 Carina Inferior wall of bifercation 90 degree,2.6 Parenchyma and interstitium,3

8、 Mediastinum,Between pleura Behind sternum In front of vertebral column Heart, vessels, trachea, root of the bronchial tree, esophagus, nerve, thymus,4 Diaphragm,Location 9-10 posterior ribs 6 anterior ribs R higher than L about 1-2cm Movement Costophrenic angle Cardiophrenic angle,III Basic X-ray c

9、hanges,1 Obstruction of bronchi,1.1 Hyperinflation and emphysema of lung Localized obstructive hyperinflation Complementary hyperinflation Diffuse obstructive emphysema,Hyperinflation: overinflation of alveoli, without destruction of alveoli Enphysema: destruction of interalveolar septa,1 Obstructio

10、n of bronchi,1.2 Obstructive atelectasis (collapse) One side atelectasis Lobar atelectasis Segmental atelectasis Lobular atelectasis,Obstruction of bronchus Lobe collapse because air in alveoli are absorbed,1.2.1 Atelectasis of an entire lung,Loss of lung volume Homogenous high density Shift of medi

11、astinum Elevation of diaphragm Crowding of ribs Compensatory overinflation of the other side,Atelectasis of left lung,1.2.2 atelectasis of a pulmonary lobe,Different lobe shows different appearance Atrophy of lobe Increase of density Movement of fissure and hilum Compensatory hyperinflation of adjac

12、ent lobes,Right upper lobe atelectasis,Right middle lobe atelectasis,Right lower lobe atelectasis,Left upper lobe atelectasis,Right upper lobe atelectasis,Right middle lobe atelectasis,Right lower lobe atelectasis,Left upper lobe atelectasis,Left lower lobe atelectasis,Segmental atelectasis wedged s

13、hadows, point to the hilum, basement outwards Lobular atelectasis small patchy shadows,1.2 Atelectasis,2. Consolidation,Exudation is an acute reaction of body to the stimulator Major reason of consolidation Pneumonia Pulmonary edema Intra-alveolar hemorrhage,Shadow with ill-defined borders Except co

14、ntact with a fissure No loss of lung volume,Air bronchogram: air-filled bronchus within the consolidatory lung tissue,3 Nodule,Round Sharp margin Acinus nodules 10mm Miliary nodules 4mm Solitary pulmonary nodules 2cm,Miliary nodules,4 Mass,2cm High density Almost round Malignant Spiculate Lobulate B

15、enignant Round Smooth,Malignant Spiculate Lobulate,Benignant Round Smooth,5 Cavity and Air containing space,Cavitation The central portion of the intrapulmonary diseases undergoes liquefaction and necrosis and is coughed up through bronchi and replaced by air Ring shadow of radiolucency with complet

16、e wall Thick-walled cavitation 3mm Thin-walled cavitation 3mm Cavum abnormal enlargement,Thick-walled cavitation,Thin-walled cavitation,Cavum Bullae,6 Reticular, liner and band shadows of lung,Due to interstitial disease Reticular or fine, linear pattern Fuzzy or prominent,Fibrosis,7 Calcification,V

17、ery high density May be local or diffuse,8 Pleural effusion,abnormal accumulation of fluid in the pleural space 8.1 Free effusion less amount when 300ml, the costophrenic angle become blunt middle amount upwardly concave meniscus ascend the lateral chest wall (meniscus sign); below the 2nd anterior

18、ribs transverse line massive amount mediastinal shift to the contralateral side; above the 2nd anterior ribs transverse line,8.2 Localized effusion,a. Loculated pleural effusion,b. Infrapulmonary effusion,stand,Lie down,Oblique 600,Lateral 1/3,Lie down,stand,b. Infrapulmonary effusion,c. Interlobar effusion,9. Pneumothorax Hydropneumothorax,Pneumothorax Presence of air in the pleural space Hydropneumothorax Presence of both air an