胸部急症CT诊断.ppt

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1、胸部急症CT大致分类n胸外伤n自发性气胸n支气管异物n心包填塞n主动脉瘤(非急症)n主动脉夹层胸外伤n原因：车祸、摔伤、火器伤、刀刺伤n阳性征象：胸廓骨折肺挫裂伤，肺挫伤肺裂伤肺内血肿肺气囊胸腔积液、气胸、纵隔气肿，颈胸部皮下及肌间气肿心脏、大血管损伤膈肌损伤男，30岁，肺挫裂伤（外伤性肺大泡）女，55岁，外伤后就诊，左肺挫裂伤，左侧气胸同一病例，左侧多发肋骨骨折同一病例，VR图像直观显示骨折部位、移位情况男，43岁，外伤就诊，矢状位图像示胸骨骨折、纵隔气肿，脊柱多发骨折膈破裂男，55岁，颅脑、胸腹外伤就诊左侧多发肋骨骨折心脏破裂男，43岁，剪刀刺伤左胸部3小时就诊，神志不清自发性气胸男，27

2、岁，突发胸痛就诊，肺尖见有多发肺大泡纵隔气肿男，24岁，胸部不适就诊，无外伤支气管异物男，33岁，颅脑术后智障，误吸花生米呛咳动脉瘤n定义：主动脉扩张1.5倍正常管径 升主动脉5cm，主动脉弓、胸主动脉4cm，远侧腹主动脉3cmn原因：q变性q外伤q感染n分类：q真性q假性测量血管真正断面真性动脉瘤Wall of artery forms the aneurysmAt least one vessel layer still intactFusiformCircumferential,relatively uniform in shapeSaccularPouchlike with narro

3、w neck connecting bulge to one side of arterial wall梭形囊状假性动脉瘤nAlso called pseudoaneurysmnNot an aneurysmnDisruption of all layers of arterial wall Results in bleeding contained by surrounding structuresPseudoaneurysm:an outpouching of a blood vessel,involving a defect in the two innermost layers(the

4、 tunica intima and media)with continuity of the outermost layer,the adventitia.Alternatively,all three layers are damaged and bleeding outside of the vessel is contained by a clot or by surrounding tissue病理n真性：动脉壁各层完整，但被延伸n假性：动脉壁各层被穿透，瘤壁为纤维组织影像诊断n要点：局限性或弥漫型扩张n形状与病因关系：q梭形动脉瘤多继发于变性（与年龄因素相关）q局限并偏心性，多提示

5、感染后、外伤后起源n常规需测量主动脉瘤的外径提供信息n瘤体直径及累及范围n与主动脉主要分支的关系n血管腔内血栓的情况n是否存在泄露、破裂出现的周围渗出性改变n是否存在周围脂肪的炎性改变动脉瘤泄露、破裂征象n轻微：q动脉瘤附近的模糊区域或对比剂局限性聚集（动脉瘤与脊柱之间）n明显：q血肿临近或围绕动脉瘤q纵隔或腹膜后腔的血肿q胸腹腔积血Imaging of the acute abdomen,2003,1156Imaging of the acute abdomen,2003,1157n男，男，57岁岁n发作性心慌、发作性心慌、胸闷胸闷2月余月余n术前术前CT（上组（上组图）示升主动图）示升主动

6、脉瘤样扩张，脉瘤样扩张，主动脉瓣增厚主动脉瓣增厚n术后术后CT（下组（下组图）示升主动图）示升主动脉部分人工血脉部分人工血管置换，主动管置换，主动脉瓣置换。脉瓣置换。男，男，43岁。突发胸岁。突发胸背痛背痛7天。主动脉天。主动脉弓降部真性动脉瘤弓降部真性动脉瘤形成。形成。男，男，34岁。活动后胸背部疼痛岁。活动后胸背部疼痛7天。天。CT示示主动脉弓降部假性动脉瘤形成。主动脉弓降部假性动脉瘤形成。胸主动脉瘤（男，76岁，以纵隔占位就诊）胸主动脉瘤（男，69岁）男，40岁，主动脉瓣置换病史男，22岁主动脉夹层n主动脉夹层指主动脉腔内的血液通过内膜的破口进入主动脉壁中层而形成的壁内血肿，并非主动脉壁

7、的扩张危险因素nCommon predisposing factors in the International Registry of Aortic Dissection(IRAD)were hypertension in 72%of cases,followed by atherosclerosis in 31%and previous cardiac surgery in 18%国际主动脉夹层官方记录（国际主动脉夹层官方记录（IRAD）显示，最常见的危险）显示，最常见的危险因素为高血压，占病例的因素为高血压，占病例的72；其次为动脉粥样硬化，占；其次为动脉粥样硬化，占31；心脏手术史，占

8、；心脏手术史，占18 nAnalysis of the young patients with dissection(,40 years of age)revealed that younger patients were less likely to have a history of hypertension(34%)or atherosclerosis(1%),but were more likely to have Marfan syndrome,bicuspid aortic valve,and/or prior aortic surgery 针对年轻患者的分析显示年轻患者（针对年轻

9、患者的分析显示年轻患者（40岁）较少有高血岁）较少有高血压病史（占压病史（占34）及动脉粥样硬化史（）及动脉粥样硬化史（1），而马凡氏），而马凡氏综合征史、主动脉瓣双瓣畸形和（或）主动脉手术史可能综合征史、主动脉瓣双瓣畸形和（或）主动脉手术史可能性更大性更大分型nDeBakeynStanford胸主动脉解剖Anatomy of the thoracic aorta and significant landmarks.The ascending aorta extends from the aortic valve to the origin of the innominate artery.I

10、ts proximal portion,in relation to the aortic valve and sinuses of Valsalva,is termed the aortic root.The aortic arch begins at the innominate artery and ends at the ligamentum arteriosum.Its most distal part,which is often slightly narrowed,is termed the aortic isthmus.The descending aorta begins a

11、t the ligamentum.Its proximal portion may appear slightly dilated and has been termed the aortic spindle.男，30岁，突发剧烈胸痛就诊主动脉边缘毛糙主动脉边缘毛糙DeBakey 型，伴左肾梗死男，28岁，突发剧烈胸痛就诊心电门控扫描，DeBakey 型，累及右侧冠状动脉起始部斜矢状图像VR图清晰显示假腔范围，并发峡部囊状动脉瘤女，49岁，降主动脉支架置入病史Debakey 型Debakey 型，左肾动脉起源于假腔鉴别升主动脉搏动伪影，门控扫描可消除肺动脉栓塞入院查D-二聚体439（正常20-250）同一病例，MIP图像RightLeft女，59岁肺动脉内多发充盈缺损右心室、房内充盈缺损，粘液栓？LeftRight