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RadiodiagnosisintheRespiratorySystem呼吸系統(tǒng)X線診斷貴州省人民醫(yī)院放射科唐雷Section1ThelungsThethoraciccage胸廓Thethoraciccageisinsymmetry(對稱)ornot.Theribsandtheotherbonesseen,appeartobenormal,orindestruction(骨質破壞),ormalformation(畸形),anddeformation(變形).Theintercostalspaces(肋間隙)aresymmetricalornot,broadened,ornarrowed.Softtissuesseemnormalorabnormal.2.ThelungsLocation:Iflesionsarelimitedbyboundariesofalobe(肺葉)orasegment(肺段),thelocationofthelesionisdefinedanddescribeddirectlywiththespecificlobeorsegment.Ifthelesionhasamassiverangeandvaguemargin,itcanbedescribedaccordingtotheupper,middleorlowerregionsfromtoptobottom,andinner,middleorouterzonesfrominsidetooutsideofthelungfields.Lungfields(肺野)andpulmonaryzones(肺帶)upperlungfieldmiddlelungfieldlowerlungfieldInnerpulmonaryzonemiddlepulmonaryzoneouterpulmonaryzoneLunglobes(肺葉)andsegments(肺段)superiorlobeofleftlung(左肺上葉)

inferiorlobeofleftlung(左肺下葉

)superiorlobeofrightlung(右肺上葉)

middlelobeofrightlung(右肺中葉)

inferiorlobeofrightlung(右肺下葉)

Lunglobes(肺葉)andsegments(肺段)posterior背anteromedialbasal前內(nèi)lateralbasal外側基底posteriorbasal后基底segmentofsuperior

lobeofleftlungsegmentofinferior

lobeofleftlungapicoposterior尖后anterior前superiorlingular上舌inferiorlingular下舌posterior背anteriorbasal前基底medialbasal內(nèi)側基底lateralbasal外側基底posteriorbasal后基底segmentofsuperior

lobeofrightlungsegmentofmiddle

lobeofrightlungsegmentofinferior

lobeofrightlungapical尖posterior后anterior前l(fā)ateral外側medial內(nèi)側Sizesofopacitiescanbedescribedaccordingtothenumberofintercostalspaces,lobesandsegmengtsand/ordirectmeasurements.Ifalesionisround,thediametercanindicateitssize.(2)Sizesofopacities:(3)Shapesofshadows:miliaryshape粟粒狀Spotsorpatches斑點狀或斑片狀Singlesmallnodule單發(fā)小結節(jié)狀Multiplenodules多發(fā)結節(jié)狀Mass團塊狀Fog-likeshadow云霧狀陰影Consolidation實變Calcification鈣化Flocculentopacities絮狀陰影Stripe-likeopacities索條狀影Cavityshadows空洞影Honeycombshadows蜂窩狀影Reticularshadows網(wǎng)狀陰影Themarginsoflesionscanbemanifestedasfuzzy(模糊),clear(清晰),sharp(銳利),smooth(光整),irregular,radiating(放射狀),spiculation(毛刺狀),andetc.(5)Relationshipbetweenlessionsandthesurroundingtissues:Pulmonaryatelectasis(肺不張)pullsadjacentmediastinumtotheaffectedside.Lungcancercaninfiltrate(侵犯)

thoracicvertebrae(胸椎)andadjacentribs.

(4)Margins:3.Thepulmonaryhilum(肺門):Hilarenlargement,decrease,nodules,mass,calcification,reationshipwithmediastinum,alterationofdensity,anddisplacement.4.Themediastinum(縱隔):Observationshouldincludelocationofthetrachea(氣管),widthofthemediastinum;location,size,shape,displacementoftheheartandgreatvessels.5.Thediaphragm(膈?。?Assessmentshouldinvolveshapeofsurface,andsharpnessofthecostophrenicangles(肋膈角).CasesinthelungsCase1.正常胸片Thethoraciccageremainssymmetrical.Alltheseenbonesarenothingremarkable.Thetrachealocatescentrallywithoutdeviation.Thelungsareclear,whilethelungmarkingsarenaturalandregular.Bothpulmonaryhilashowneitherenlargementnordecrease.Theheartandgreatvesselsappearnormalintheirposition,sizeandshape.Thediaphragmhasasmoothsurfacewithsharpcostophrenicangles.Diagnosis:Normalinthelungs,heart,anddiaphragm.Case2.患兒2y,咳嗽1周Thethoraciccageremainssymmetrical.Alltheseenbonesarenothingremarkable.Thetrachealocatescentrallywithoutdeviation.Thelungsmarkingsbecomethickenedintheinnerandmiddlezonesofbilateralmiddleandlowerlungfields.Somescatteredpatch-likeinfiltrationsmixwiththethickenedlungmarkings.Theirmarginsappearvague.Bothpulmonaryhilashowblurred,butnotinevidentenlargemen.Thereisnothingremarkableintheheartandgreatvessels.Thediaphragmhasasmoothsurfacewithsharpcostophrenicangles.Diagnosis:Bronchopneumonia.(支氣管肺炎)Case3.男,18y,咳嗽1周、發(fā)熱2天Thethoraciccageremainssymmetrical.Alltheseenbonesarenothingremarkable.Thetrachealocatescentrallywithoutdeviation.

Thereisalargepatchyhomogeneousopacityintherightmiddlelobewithaslightlyfuzzymargin.Itcoverstherightpulmonaryhilum.Therestofthelungsremainclear.Theleftpulmonaryhilumhasnoenlargement.Nosuspectedsignsarefoundintheheartandgreatvessels.Thediaphragmhasasmoothsurfacewithsharpcostophrenicangles.Diagnosis:Pneumonia(肺炎)intherightmiddlelobe.Re-examinationissuggestedaftertreatment.Case4.高熱、咳嗽、膿痰10天Thereisalargeround-likeopacityintheposteriorsegmentoftheleftlowerlungwithafuzzymargin,inthesizeof2.0cm×3.0cm.Acavitycanbefoundwithanair-fluidlevel(氣液平面)intheshadow,

whichinvolvestheleftpulmonaryhilumandadjacentlung.Nothingisspecialintheheart,diaphragmandrightlung.Diagnosis:Apulmonaryabscessintheposteriorsegmentoftheleftlowerlung.Case5.腮腺腺樣囊性癌術后3年,復發(fā)2月Thethoraciccageremainssymmetrical.Alltheseenbonesarenothingremarkable.Multiplenoduleswithclearmarginsaredis-playeddiffuselyinbothlungsindifferentsizes.Bothpulmonaryhilashowneithere

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