胸部急症CT诊断

胸部急症CT胜利油田中心医院CT检查科宋殿行2013-10-09大致分类胸外伤自发性气胸支气管异物心包填塞主动脉瘤(非急症)主动脉夹层2013-10-09胸外伤原因：车祸、摔伤、火器伤、刀刺伤阳性征象：胸廓骨折肺挫裂伤，①肺挫伤②肺裂伤③肺内血肿④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2013-10-09男，30岁，肺挫裂伤（外伤性肺大泡）2013-10-09女，55岁，外伤后就诊，左肺挫裂伤，左侧气胸2013-10-09同一病例，左侧多发肋骨骨折2013-10-09同一病例，VR图像直观显示骨折部位、移位情况2013-10-09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2013-10-09膈破裂男，55岁，颅脑、胸腹外伤就诊2013-10-092013-10-09左侧多发肋骨骨折2013-10-09心脏破裂男，43岁，剪刀刺伤左胸部3小时就诊，神志不清2013-10-092013-10-092013-10-09自发性气胸男，27岁，突发胸痛就诊，肺尖见有多发肺大泡2013-10-09纵隔气肿男，24岁，胸部不适就诊，无外伤2013-10-09支气管异物男，33岁，颅脑术后智障，误吸花生米呛咳2013-10-092013-10-09动脉瘤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3cm原因：变性外伤感染分类：真性假性2013-10-092013-10-09测量血管真正断面真性动脉瘤WallofarteryformstheaneurysmAtleastonevessellayerstillintactFusiformCircumferential,relativelyuniforminshapeSaccularPouchlikewithnarrowneckconnectingbulgetoonesideofarterialwall梭形囊状2013-10-09假性动脉瘤AlsocalledpseudoaneurysmNotananeurysmDisruptionofalllayersofarterialwallResultsinbleedingcontainedbysurroundingstructuresPseudoaneurysm:anoutpouchingofabloodvessel,involvingadefectinthetwoinnermostlayers(thetunicaintimaandmedia)withcontinuityoftheoutermostlayer,theadventitia.Alternatively,allthreelayersaredamagedandbleedingoutsideofthevesseliscontainedbyaclotorbysurroundingtissue2013-10-09病理真性：动脉壁各层完整，但被延伸假性：动脉壁各层被穿透，瘤壁为纤维组织2013-10-09影像诊断要点：局限性或弥漫型扩张形状与病因关系：梭形动脉瘤多继发于变性（与年龄因素相关）局限并偏心性，多提示感染后、外伤后起源常规需测量主动脉瘤的外径2013-10-09提供信息瘤体直径及累及范围与主动脉主要分支的关系血管腔内血栓的情况是否存在泄露、破裂出现的周围渗出性改变是否存在周围脂肪的炎性改变2013-10-09动脉瘤泄露、破裂征象轻微：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）明显：血肿临近或围绕动脉瘤纵隔或腹膜后腔的血肿胸腹腔积血2013-10-09Imagingoftheacuteabdomen,2003,11562013-10-09Imagingoftheacuteabdomen,2003,11572013-10-092013-10-092013-10-09男，57岁发作性心慌、胸闷2月余术前CT（上组图）示升主动脉瘤样扩张，主动脉瓣增厚术后CT（下组图）示升主动脉部分人工血管置换，主动脉瓣置换。2013-10-09男，43岁。突发胸背痛7天。主动脉弓降部真性动脉瘤形成。2013-10-092013-10-09男，34岁。活动后胸背部疼痛7天。CT示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）2013-10-092013-10-092013-10-09胸主动脉瘤（男，69岁）2013-10-092013-10-092013-10-09男，40岁，主动脉瓣置换病史2013-10-092013-10-09男，22岁2013-10-092013-10-092013-10-092013-10-09主动脉夹层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，并非主动脉壁的扩张危险因素CommonpredisposingfactorsintheInternationalRegistryofAorticDissection(IRAD)werehypertensionin72%ofcases,followedbyatherosclerosisin31%andpreviouscardiacsurgeryin18%国际主动脉夹层官方记录（IRAD）显示，最常见的危险因素为高血压，占病例的72％；其次为动脉粥样硬化，占31％；心脏手术史，占18％Analysisoftheyoungpatientswithdissection(,40yearsofage)revealedthatyoungerpatientswerelesslikelytohaveahistoryofhypertension(34%)oratherosclerosis(1%),butweremorelikelytohaveMarfansyndrome,bicuspidaorticvalve,and/orprioraorticsurgery针对年轻患者的分析显示年轻患者（40岁）较少有高血压病史（占34％）及动脉粥样硬化史（1％），而马凡氏综合征史、主动脉瓣双瓣畸形和（或）主动脉手术史可能性更大2013-10-09分型DeBakeyStanford2013-10-09胸主动脉解剖2013-10-09Anatomyofthethoracicaortaandsignificantlandmarks.Theascendingaortaextendsfromtheaorticvalvetotheoriginoftheinnominateartery.Itsproximalportion,inrelationtotheaorticvalveandsinusesofValsalva,istermedtheaorticroot.Theaorticarchbeginsattheinnominatearteryandendsattheligamentumarteriosum.Itsmostdistalpart,whichisoftenslightlynarrowed,istermedtheaorticisthmus.Thedescendingaortabeginsattheligamentum.Itsproximalportionmayappearslightlydilatedandhasbeentermedtheaorticspindle.2013-10-09男，30岁，突发剧烈胸痛就诊主动脉边缘毛糙DeBakeyⅠ型，伴左肾梗死2013-10-092013-10-09男，28岁，突发剧烈胸痛就诊2013-10-092013-10-09心电门控扫描，DeBakeyⅠ型，累及右侧冠状动脉起始部斜矢状图像2013-10-09VR图清晰显示假腔范围，并发峡部囊状动脉瘤2013-10-09女，49岁，降主动脉支架置入病史2013-10-092013-10-09DebakeyⅡ型DebakeyⅢ型，左肾动脉起源于假腔2013-10-09鉴别升主动脉搏动伪影，门控扫描可消除2013-10-09肺动脉栓塞入院查D-二聚体439（正常20-250）2013-10-09同一病例，MIP图像RightLeft2013-10-092013-10-09女，59岁2013-10-09肺动脉内多发充盈缺损2013-10-09右心室、房内充盈缺损，粘液栓？2013-10-09LeftRight2013-10-092013-10-09希望有所收获