醫(yī)學(xué)教學(xué)課件英文版：Radiodiagnosis in the Circulatory System

*381RadiodiagnosisintheCirculatorySystem*382Questions

1.HowtotaketheradiographiesofPAandLA?2.Whatarethenormalfindingsofthelung?3.Howtodemarcatethelungfieldsandpulmonaryzones?4.Todescribethelunganatomy.5.Todescribelesionsinmassandexudationinthelung.*383Techniques

PA

LL*384NormalChestFilms*385DescriptionofNormalChestFilmsThethoraciccageremainssymmetrical.Alltheseenbonesarenothingremarkable.Thesofttissuesarecompletelyintactintherootoftheneckandthoracicwall.Thetrachealocatescentrallywithoutdeviation.Thelungsareclear,whilethelungmarkingsarenaturalandregular.Bothpulmonaryhilashowneitherenlargementnordecrease.Theheartandgreatvesselsappearnormalintheirposition,sizeandshape.Thediaphragmhasasmoothsurfacewithsharpcostophrenicangles.*386DescriptionofpulmonarytumorsTherearetwosofttissuemassesintherightlung.Onelocatesintheinferiormarginoftherightupperlobe,andotherisintheinferiorpartofrightpulmonaryhilum.Themarginofthemassintherightupperlungrevealsevidentspiculation,however,themarginoftherighthilarmassissmooth.Thedensitiesofthemassesareuniformintherightupperlungandtherighthilumseperately.

*387AimandRequirements

1.TomakefamiliarwithnormalX-rayfindingsintheheart.2.TomakefamiliarwithX-rayfindinginenlargementoftheventriclesandatriaoftheheart.3.Toknowwellthechangesofpulmonarybloodvolume.*388HeartAhollowmuscularcone-shapedorgan,lyingbetweenthelungswithpointedend(apex)directeddownwards,forwards,andtotheleft.Theheartisaboutthesizeofaclosedfist.Itswallconsistslargelyofcardiacmuscle(myocardium,therearetwotypesofcardicmyocytes,autorhythmicandcontractile[k?n'tr?ktail]),linedandsurroundedbymembranes(endocardium[.end?u'kɑ:di?m]andpericardium[.peri'kɑ:di?m]).

*389Itisdividedbyseptumintoseparaterightandlefthalves,eachofwhichisdividedintoanupperatrium['eitri?m]

andalowerventricle['ventrik?l]

.Deoxygenatedbloodfromthevenacavapassesthroughtherightatriumtotherightventricle.Thiscontractsandpumpsbloodtothelungsviathepulmonaryartery.Thenewlyoxygenatedbloodreturnstotheleftatriumviathepulmonaryveinsandpassesthroughtotheleftventricle.Thisforcefullycontracts,pumpingbloodouttothebodyviatheaorta.Thedirectionofbloodflowwithintheheartiscontrolledbyvalves[v?lvs].

*3810*3811*3812*3813CardiacTeleradiograph*3814CTHighdensityresolutionHighspatialresolutionHightemporalresolutionSpiralCTEBCT*3815*3816AorticDissectingAneurysm

tunicaintima,tunicamedia,tunicaadventitia*3817*3818*3819MRIHightissueresolutionOne-stopshopMorphologyFunctionViability*3820*3821MRFUNCTIONANATOMYFLOWVIABILITYPERFUSIONMETABOLISMMRANGIOGRAPHY*3822

CE-MRPA*3823CardioangiographyDSA，digitalsubtractionangiographyGoldstandardforCADIntenventionDiagnosisandtreatment*3824VentriculographySystole

Diastole['sist?.li:]

[dai'?st?li]

*3825*3826CardiothoracicRatio*3827

Thecardiothoracicratio=(T1＋T2)/T

Calculationofthecardiothoracicratiohasbeenthesimplestandmostfrequentlyusedmethodformeasurementoftheheart.Theratioisdefinedasthevalueofthetransversedimensionoftheheartdividedbytheinnerdimensionofthethoraciccavityatthelevelofcrossingthedomeoftherighthemidiaphragm.*3828ValueoftheRatioOnPA,relationbetweensizeoftheheartandthecardiothoracicratioNormalheartlessthan0.52Slightenlargement0.52～0.55Moderateenlargement0.56～0.60Severeenlargementmorethan0.60*3829

PALL*3830

RAOLAO*3831Enlargementoftheleftventricle

PALLLAOLAO*3832Enlargementoftheleftventricle

OnPAandLL,theextensionoftheleftventricledevelopsleftwardalongtheposteroinferiordirection.TheLAOissuitableforobservationoftheenlargementintheleftventricle,theefferenttractoftheleftheartanddistortionandelevationoftheaorta.*3833Enlargementoftheleftatrium

PALLLLLL*3834Enlargementoftheleftatrium

OnPA,thereisthedoublecontoursignontherightborderandashadowwith4archesontheleftmarginoftheheart.TheenlargedleftatriumcompressestheesophagusindistortionanddisplacementonLL.*3835Enlargementoftherightventricle

PALLRAOLAO*3836EnlargementoftherightventricleOnPA,theenlargedrightventricleextendstobothsideswithelevationofthecardiacapex.Thesegmentofthepulmonaryarteryprotrudesobviously.OnLLview,theprecardiacspacedecreasesordisappears.Theinterfacebetweentherightventricleandthesternumoccupiesmorethan1/3oftheheightofthesternum.OnRAOview,thefilmcanshowbulgingofthesegmentofthepulmonaryarteryandenlargementoftherightventricle.OnLAOview,theprecardiacandpostcardiacspacesbecomenarrow.*3837Enlargementoftherightatrium

PARAOLAOLL*3838EnlargementoftherightatriumOnPAview,thereisabulginginthesecondarchoftherightheartborder.Thevalueofa/bcanbemorethan1/2.OnRAOview,thepostcardiacspacedecreasesintheinferioronesecondoftheretrocardiacclearancewithoutcompressionanddisplacementoftheesophagus.OnLAO,thespaceisoccupiedbyabulgingoftheanterosuperiorborderoftheheart.OnLLview,theenlargedrightatriumisnoteasilyfoundduetooverlapping.*3839Changesofpulmonarybloodvolume

a.Diameteroftherightinferiorpulmonaryartery:Thediameterisnomorethan1.5cmintherightlowerpulmonaryarteryinthenormalstate,whichismeasuredattheinferiormarginintheintersectionbetweentherightinferiorpulmonaryarteryandtherightsuperiorpulmonaryvein(Fig.3-32).*3840*3841

b.Pulmonaryarterialcongestion

Pulmonaryarterieshavebeenbroadenedinallitstrunksandbranches.Pulmonaryvenouspleonaemiareferstothesituationthatexcessivebloodstagnatesinthepulmonaryveins.So,thelungfieldshaveanattenuatedradiolucencyandseemlikegroundglass.Redistributionofthepulmonarybloodmayhappenbetweentheupperandthelowerlungfields.Doctorsshouldbewatchfulforthesignsofpulmonaryarterialhypertensionandthesignofpulmonaryhilardanceunderfluoroscopy.*3842VentricalarSeptaDefect*3843PulmonaryOligaemia[?li'd?i:mi?]

Thecauseisbasedonthesuffocationo