胸部正常CT斷層解剖圖片ppt課件

1、胸部正常CT解剖,1,目 錄,概論 縱隔窗的CT解剖 肺窗的CT解剖,2,前 言 肺、縱隔內(nèi)部組織結(jié)構(gòu)之間、正常結(jié)構(gòu)與病變之間的密度差異 CT滿意顯示胸部正常結(jié)構(gòu)和病灶的大體解剖，定位、定量準(zhǔn)確，為定性分析提供形態(tài)學(xué)基礎(chǔ),3,有關(guān)胸部CT檢查技術(shù)的幾個問題 1、CT值與窗寬、窗位：肺窗和縱膈窗，雙 窗技術(shù) 2、層厚和層距：吸氣末掃描，薄層/重疊掃 描；減小部分容積效應(yīng)、肺血墜積現(xiàn)象 3、平掃和增強(qiáng)掃描：LN，病灶，血管 4、高分辨CT（High Resolution ,HRCT） 層厚 12mm，顯示次級肺小葉結(jié)構(gòu)； 顯示間質(zhì)性病變、支擴(kuò)、孤立小病灶,4,5,6,7,8,9,10,11,12,

2、胸部正常CT解剖,縱隔窗,13,一、 主要觀察內(nèi)容 1、縱膈：有無縱膈腫塊、多余結(jié)構(gòu) LN有無腫大或/及增多 “三管”結(jié)構(gòu)形態(tài)（氣道結(jié)合肺窗） 2、較大范圍的肺、胸膜（腔）病變的內(nèi)部 結(jié)構(gòu) 3、閱片順序： 辨認(rèn)每一層縱膈內(nèi)的“三管”結(jié)構(gòu) 自上而下、由近段向遠(yuǎn)段 完整觀察某一結(jié)構(gòu),14,主要層面和結(jié)構(gòu),主動脈弓及其以上層面：辨認(rèn)頭臂血管 主-肺動脈窗層面：窗空虛/潛在，氣管分叉，奇V弓 右上葉支氣管層面：左PA弓、右上PV前干，右上PA，上腔V 左上葉支氣管層面：右中間段支氣管，右PA，右下PA，左上PV，左PA降支 其他肺門層面：兩側(cè)大小基本對稱（肺窗顯示更佳），相伴隨的支氣管和PA分支，由近

3、向遠(yuǎn)漸小,15,16,17,18,19,Can you find the right and left subclavian arteries? (click for answer),20,The right subclavian artery as it dumps into the brachiocephalic artery. (click to highlight),21,What are the 3 yellow air-filled (black) structures highlighted here? (click to highlight),22,This is contra

4、st (white) being injected into the left subclavian vein.,23,Can you find the first 3 branches off the aortic arch? (click for answer),24,Incidental lipoma (fat tumor) (notice it is the same density as fat in the chest wall),25,26,27,Can you find the left brachiocephalic vein as it dumps into the SVC

5、?(click for answer),28,We are at the level of the top of the aortic arch (click to highlight),29,Can you find the right pectoralis major and minor? (click for answer),30,What is the structure in blue? (click to highlight),This is the Superior Vena cava,31,32,33,Can you find the azygous arch ? (where

6、 the azygous vein comes across to dump into the SVC) (click for answer),34,35,Notice the bifurcation of the trachea (corina) at this level (click to highlight),36,37,What is the structure in red? (click to highlight),This is the left pulmonary artery.,38,39,40,41,Can you find the pulmonary trunk and

7、 right pulmonary artery? (click for answer),42,Where are the ascending (A) and descending (D) limbs of the thoracic aorta? (click to highlight),43,44,We are at the level of the top of the left atrium. Notice The pulmonary veins dumping into it as they return from the lungs. (click to highlight),45,C

8、an you find the left main coronary artery coming off the aorta? (click for answer),46,You can further see The left coronary branch into the Circumflex artery and the LAD artery (click to highlight),47,48,Here is a good image of the aortic semi-lunar valve leaflets. Can you find them? (click for answ

9、er),49,Here is a good image of the left atrium dumping Into the left ventricle. Can you find it? (click to highlight),50,You can clearly see the left ventricular wall and septum with the projecting papillary wall muscles attaching to the mitral valve leaflets. (click to highlight),51,Contrast fillin

10、g the right ventricle,52,Can you find the pericardial sac here? (click for answer),It is relatively easy to see because there is a fat layer around the heart and around the pericardium making the soft tissue more visible,53,縱膈的分區(qū)方法：CT較平片 （側(cè)位）直接顯示 前縱膈 - 心臟、大血管前 間隙，胸腺 中縱膈 - “三管”結(jié)構(gòu)及其 周圍間隙、LN 后縱膈 - 脊柱旁（

11、溝）； 脊神經(jīng)、植物神經(jīng) 心臟和心包,54,55,56,57,58,59,60,胸部正常CT解剖,肺窗,61,一、主要觀察內(nèi)容 1、CT肺門（肺野內(nèi)帶）：第一、二肺門之間的血 管、支氣管等 內(nèi)側(cè) - 與縱膈內(nèi)支氣管、血管相續(xù)（結(jié)合縱膈窗） 外側(cè) - 段支氣管開口處，與外周支氣管血管束相續(xù) 2、支氣管血管束（肺野中帶） 由肺門發(fā)出的、相伴行的支氣管和肺A分支； 向肺門/左房回流的、無支氣管伴行的肺靜脈 3、外周肺（胸膜下區(qū)）：段以下的血管、支氣管斷面 影，呈小條、星、叉、點(diǎn)狀 4、閱片要點(diǎn)：抓住重點(diǎn)層面， 觀察每一層時，注意上下相鄰層面， 完整觀察某一結(jié)構(gòu),62,二、主要層面和結(jié)構(gòu) 標(biāo)志：與肺門相續(xù)的支氣管、血管 1、右上葉支氣管以上層面： 兩側(cè)尖段支氣管及其外側(cè)的同名動脈 2、右上葉支氣管層面：右主支氣管，前、后段支氣管， 右PA上干；右上PV前干 左上前段支氣管 3、右中間段支氣管層面：葉間動脈（右下PA 干） 4、左上葉支氣管層面：左主、左上葉支氣管 5、右中葉、左舌