醫(yī)學(xué)mediastinummodadam的學(xué)習(xí)資料

醫(yī)學(xué)mediastinummodadam的學(xué)習(xí)資料第1頁(yè)/共70頁(yè)MediastinumBoundedlaterallybyparietalpleuraofeachlungSuperiormarginisthoracicinletDefinedbyplaneof1stribsInferiormarginisdiaphragmTissueplanesextendsuperiorlyintoneckaroundgreatvessels,tracheaandesophagusConnectstoabdominalcavityviaesophageal,cavalandaortichiatusesConnectstolungsalonghilarvesselsandbronchi第2頁(yè)/共70頁(yè)MediastinumRadiologicanatomyCXRCTNormalornot?Compartmentsandtheirpathologies:AnteriorMiddlePosterior第3頁(yè)/共70頁(yè)RadiologicAnatomyLandmarkstolookforonthechestradiograph:TracheaParatrachealstripeDescendingaorticcontourAzygo-esophagealcontour第4頁(yè)/共70頁(yè)P(yáng)neumomediastinumwithcervicalemphysema第5頁(yè)/共70頁(yè)TrachealaircolumnShouldbestraightSlightbendtorightduetoaorticarchonitsleft.第6頁(yè)/共70頁(yè)Tracheadeviatestotheleft第7頁(yè)/共70頁(yè)RightAorticArch第8頁(yè)/共70頁(yè)RightparatrachealstripeExtendsfromthoracicinlettoazygosveinWidensoutatazygosveinNomorethan3-4mmthick第9頁(yè)/共70頁(yè)SarcoidOldfilm第10頁(yè)/共70頁(yè)Aorticcontour第11頁(yè)/共70頁(yè)Azygo-esophagealrecess第12頁(yè)/共70頁(yè)Aorticcontourandazygo-esophagealrecessabnormal第13頁(yè)/共70頁(yè)Normalanatomy:

CT/CXRcorrelation第14頁(yè)/共70頁(yè)Normalanatomy:

CT/CXRcorrelation第15頁(yè)/共70頁(yè)Normalanatomy:

CT/CXRcorrelation第16頁(yè)/共70頁(yè)Normalanatomy:

CT/CXRcorrelation第17頁(yè)/共70頁(yè)Isthemediastinumwide?Firstask…isittechnical?Positioning:rotated:?AP?Lordotic?Supine?InspirationIfso,repeatthefilmbeforeproceedingtoCT.Thenask…Isitnew?GETOLDFILMS

beforegettingaCTunlesstimeiscritical.第18頁(yè)/共70頁(yè)30yearoldmaninmotorvehicleaccident第19頁(yè)/共70頁(yè)APsupineAPuprightPAupright第20頁(yè)/共70頁(yè)Thinkaboutnormalvariants!VascularstructuresAorticanomaliesTortuousvesselsAzygosveinLipomatosisFatpads第21頁(yè)/共70頁(yè)Severeasthmaonlongtermsteroids第22頁(yè)/共70頁(yè)Mediastinallipomatosis第23頁(yè)/共70頁(yè)第24頁(yè)/共70頁(yè)P(yáng)ericardialFatPad第25頁(yè)/共70頁(yè)第26頁(yè)/共70頁(yè)Tortuousbrachiocephalicvessels第27頁(yè)/共70頁(yè)第28頁(yè)/共70頁(yè)AzygoscontinuationoftheIVC—congenitalvariant第29頁(yè)/共70頁(yè)70yearoldwithdysphagiaTrachealaircolumn第30頁(yè)/共70頁(yè)Esophagealcancer第31頁(yè)/共70頁(yè)AbnormalrightparatrachealstripeHodgkinsdisease第32頁(yè)/共70頁(yè)Abnormalrightparatrachealstripe第33頁(yè)/共70頁(yè)Checktheoldfilm!2daysearlierHematomafromlineinsertion第34頁(yè)/共70頁(yè)OneyearagoAbnormalrightparatrachealstripeandaorticarchobscured第35頁(yè)/共70頁(yè)第36頁(yè)/共70頁(yè)第37頁(yè)/共70頁(yè)Tumorobscuringthetopoftheaorticarch第38頁(yè)/共70頁(yè)AirfluidlevelsThinkbowelorabscess:HiatalherniaZenkerdiverticulumEpiphrenicdiverticulumAchalasiaMediastinalabscess第39頁(yè)/共70頁(yè)Achalasia第40頁(yè)/共70頁(yè)Zenkerdiverticulum第41頁(yè)/共70頁(yè)Hiatalhernia第42頁(yè)/共70頁(yè)MediastinalabscessafterCABG第43頁(yè)/共70頁(yè)DifferentialdiagnosisofmediastinalmassesTraditionally,wedividethemediastinumintocompartments.LikelydiagnosisofmassdependsonwhatiscontainedineachcompartmentThesearenotanatomicboundaries,andmassescommonlycrossoverintocompartmentswheretheydon’t“belong”.第44頁(yè)/共70頁(yè)P(yáng)osteriormediastinumParaspinalareaMassesusuallyvisibleonlateralfilmoverlyingspineMayobscuredescendingaortacontour第45頁(yè)/共70頁(yè)P(yáng)osteriormediastinumNeurogenictumorsSchwannomaSympatheticnervetumorse.g.ganglioneuromaNeurentericcyst,lateralmeningoceleLymphnodes(unusualasonlyareainvolved)ExtramedullaryhematopoesisVertebraltumors,spurs第46頁(yè)/共70頁(yè)Schwannoma第47頁(yè)/共70頁(yè)Extramedullaryhematopoesis第48頁(yè)/共70頁(yè)LateralmeningoceleinNF-1第49頁(yè)/共70頁(yè)AnteriormediastinumSpaceanteriortogreatvesselsandheart,behindthesternum第50頁(yè)/共70頁(yè)AnteriormediastinumMostcommon:LymphomaThymiclesionsGermcellorigintumorsThyroidmassesAlso:Foregutcysts,nervetumors,aorticaneurysm,etc.第51頁(yè)/共70頁(yè)AnteriormediastinalmassesThymichyperplasiateratocarcinomateratomalymphomathymomahemorrhage第52頁(yè)/共70頁(yè)MiddlemediastinumContainsheart,greatvessels,esophagus,trachea,lymphnodes,nerves.CXRabnormalityinparatrachealarea,azygo-esophagealrecess,retrocardiacareaMaybedifficulttoseeonlateralview第53頁(yè)/共70頁(yè)MiddleMediastinumLymphnodesForegutcystsVascularlesionse.g.aneurysmBronchogeniccarcinomaHiatalhernia,otheresophagealorGIlesions第54頁(yè)/共70頁(yè)Lymphoma第55頁(yè)/共70頁(yè)CardiacevaluationRemember:cardiothoracicratioofabout0.5appliesonlytogoodPAchestx-rays.Knowingwhichchambersformwhichcardiaccontourscanhelpidentifywhatisenlarged.Lookforaccompanyingsigns:PulmonaryvenousengorgementandisolatedLAenlargementsuggestsmitralstenosis.DilatedaortaandLVenlargementsuggestsaorticvalveinsufficiency.第56頁(yè)/共70頁(yè)NormalheartcontoursLeftatriumLeftventricleRightatrium第57頁(yè)/共70頁(yè)Leftatrialenlargement-mitralstenosisMitralvalve第58頁(yè)/共70頁(yè)Leftatrialenlargement“Doubledensity”StraightenedleftheartborderLAenlargedLVnormal第59頁(yè)/共70頁(yè)EnlargedascendingaortainAS第60頁(yè)/共70頁(yè)CalcificAorticStenosisEnlargedascendingaorta,normalarch,normaloverallheartsizeLVH第61頁(yè)/共70頁(yè)LVenlargement第62頁(yè)/共70頁(yè)Dilatedcardiomyopathymultichanberenlargement第63頁(yè)/共70頁(yè)ReviewQuestions第64頁(yè)/共70頁(yè)Amassthatwidenstheparatrachealstripeisprobablyinthe1.Anteriormediastinum2.Middlemediastinum3.Posteriormediastinum4.Neck第65頁(yè)/共70頁(yè)P(yáng)osteriormediastinalmassesincludeallexcept:1.Schwannoma2.Extramedullaryhematopoesis3.Thymoma4.Lymphoma第66頁(yè)/共70頁(yè)Non-pathologicalcausesofmediastinalwideningonachestradiographinclude:1.