2011年3月6日

胸部X光判讀整理

首先,檢查X光片拍得好不好
  1. 兩側Clavicle的medial ends距midline是否等距→ 若不等距,可能有Rotation
  2. Diaphragm位置是否到10'th~11'th肋間→ 若沒有,病人可能沒吸飽氣
  3. Thoracic vertebrae應該要隱約可見→ 表示X ray有適當的穿透度

位置資訊:
  • Mediastinum前中後分界:1.心臟後緣到IVC連線 2.Vertebral body前緣後1cm連線 
  • Lun在CP angle最低處到L2,積水在此可積300ml
  • Clavicle的位置在PA view比AP低 (PA約在2'th rib;AP在4'th rib)
  • Standing position時,在Stomach常可以看到Air-fluid level (supine無)

依序檢查

  1. A: Airway & Mediastinum
  2. B: Bone
  3. C: Cardiac & Great vessels
  4. D: Diaphragm (& CP angles)
  5. E: Else (lung)

Alveolar Pattern vs Interstitial Pattern
肺部最小的解剖及呼吸單位:Acinus  (3~5個acinus構成1Pulmonary lobule)

Alveolar pattern: 侵犯air space的疾病
 (ex: CHF, pulmonary edema, pneumonia)

Interstitial pattern: 侵犯Interlobular septa (造成septa水腫or變厚)
(ex: TB, Histoplasmosis, Silicosis, Asbestosis, Farmer's lung, Mushroom worker's disease, sarcoidosis, scleroderma, RA)



描述病灶:6種Abnormalities

  1. Air space disease: Consolidation
  2. Atelectasis - Collapse
  3. Pleural fluid accumulation: Effusion
  4. Masses, tumor, tumor-like lesion
  5. Overinflation: Emphysema
  6. Interstitial change: Fibrosis & Edema


1. Consolidation
利用Silhoutte sign & Cervicothoracic sign定位

Silhoutte sign: 看Aorta, Heart, Diaphragm
正常情況下,Aorta, Heart, Diaphragm被空氣包圍,界限很明顯
若Aorta, Heart, Diaphragm緊貼著病灶,它們的正常界限就會消失
若Aorta, Heart, Diaphragm沒有緊貼病灶(例:在病灶後方後方),界限依然可見
Cervicothoracic sign: 區分 Neck or Intrathoracic structure
Neck structure: 物體在clavicle上方處的界限不明顯
Intrathoracic structure: 物體在clavice上方處的界限依然可見

2. Atelectasis - Collapse
Left diaphragm與heart的border正常可見,若消失且無肺積水→LLL collapse

3. Masses

  • Extrapulmonary masses: sharp margins, tapered border, convexity toward lung
  • 邊緣Spiculation(像針狀): malignancy
  • Calcification: benign (尤其是中央鈣化or Pop corn)
  • Mediastinal mass: Anterior mediastinum最好發 (3T1L: Thymus, Thyroid, Teratoma, Lymphoma)

4. Emphysema
  • 最可靠的sign: decreased vascularity
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