膈肌病变与胸部外伤ppt演示课件

.,1,膈肌病变与胸部外伤,.,2,胸部外伤,.,3,胸部外伤影像学概论,急性外伤：车祸、利器伤、工程创伤、爆炸伤慢性外伤：强烈咳嗽、刺激气体以检查心肺情况为主注意肋骨损伤的合并症注意检查时的患者保护,.,4,肋骨骨折,容易漏诊，胸部拍片检查为主3-10肋容易发生，腋后段多见多根肋骨骨折导致胸廓塌陷变形可以并发气胸、血胸、气肿肋骨骨折必须注意复查,.,5,.,6,.,7,胸骨骨折,驾驶员多见胸骨体部多见侧位投照为主,.,8,胸部异物,胸壁异物肋骨活动方向一致胸腔内异物与重要气管的关系纵隔异物要提高条件异物的并发症,.,9,气胸与血气胸,开放或闭合损伤的严重并发症之一强烈提示肋骨骨折错位,.,10,.,11,.,12,.,13,.,14,肺挫伤contusion 0f lung,直接撞击或高压气浪间接损伤肺间质和实质内液体渗出胸痛、咳嗽,.,15,contusion 0f lung-影像,局部肺纹理模糊肺野外部斑片状模糊阴影6小时出现、48小时内开始吸收,.,16,.,17,.,18,.,19,.,20,.,21,.,22,.,23,肺撕裂伤与肺血肿,钝挫伤或震荡上引起肺组织裂伤、囊肿形成、血肿,.,24,肺撕裂伤与肺血肿-影像,局部渗出性阴影渗出阴影内囊状影球形血肿胸壁外伤其他变化,.,25,.,26,支气管撕裂伤,严重外伤所致多发生于隆突附近以明显咳血或进行性通气障碍为主要表现,.,27,支气管撕裂伤,外伤后单纯纵隔和皮下气肿肺不张肺组织下坠支气管结构连续性中断转折支气管周围积气缓发性支气管狭窄,.,28,纵隔气肿与血肿,.,29,trumaPneumomediastinum,.,30,Pulmonary Contusion / Pneumothorax,.,31,.,32,case,.,33,.,34,Tension Pneumothorax,.,35,Aortic Rupture,.,36,.,37,NG in distal esophagus,.,38,NG in right lung causing pneumothorax,.,39,Side port of chest tube outside chest wall,.,40,Central line in jugular vein,.,41,Hemopericardium(Tamponade),.,42,Spine and Rib Trauma,.,43,Flail Chest,.,44,.,45,.,46,.,47,.,48,.,49,.,50,.,51,HemothoraxLarge Pleural Effusion,.,52,.,53,膈疝diaphragmatic hernia,定义：腹部脏器穿过膈肌突入胸腔分类：先天性后天性 外伤性非外伤性 真性假性 嵌顿性滑动性 裂孔性膈肌性,.,54,膈疝-胸腹裂孔疝pleuro-peritoneal hiatus hernia,婴幼儿最常见先天性膈疝多发生于左侧疝入物可为胃、小肠、结肠、脾等可有胸腹压力变化或胃肠道症状,.,55,胸腹裂孔疝-X影像,患侧胸腔中下部密度增高，其内密度不均，可见液平面患侧膈面模糊或后侧局限性突出心脏纵向对侧移位钡剂造影显示胃肠道进入胸腔,.,56,.,57,.,58,.,59,case,.,60,case,.,61,case,.,62,case,.,63,.,64,.,65,.,66,.,67,Morgagni Hernia,.,68,DDX -CAM,.,69,DDX-CLE,.,70,胸腹裂孔疝-CT、MRI,膈肌后外侧膈肌完整性缺损局部异常密度或组织影进入胸腔,.,71,胸腹裂孔疝-诊断,下胸部异常密度影应怀疑裂孔疝可能胃肠道进入胸腔为特征性表现设法显示膈肌形态变化确诊,.,72,DDX-Cystic Adenomatoid Malformation,.,73,DDX-Congenital Lobar Emphysema,.,74,.,75,外伤性膈疝traumatic diaphragmatic hernia,外伤直接割裂或腹腔压力突然增高冲击造成膈肌破裂，腹腔脏器突入胸腔多发于左侧：开放性、闭合性疝入物：多种可能临床：无 晚发性间歇性胃肠症状、左胸痛 呼吸困难、胸痛、休克,.,76,外伤性膈疝-X影像,左侧膈面局限性模糊或消失胸腔下部密度不均异常阴影或见肠袢下位肋骨错位性骨折下胸部进行性增大含液平面阴影钡剂检查胃肠管进入胸腔或有嵌顿,.,77,Case1:The patient was a restrained driver of a vehicle struck on the passenger side in an MVA.,.,78,.,79,.,80,.,81,.,82,.,83,.,84,.,85,外伤性膈疝-CT、MRI,膈肌连续性中断胸腔内显示腹腔脏器,.,86,.,87,外伤性膈疝-诊断,外伤史下胸部异常密度影及膈肌变化钡剂造影,.,88,膈膨升diaphgamatic eventration,膈肌发育不良，肌层薄弱上移局限性、弥漫性原因：肌纤维发育不良、膈神经损伤、腹腔压力突然增高无症状/呼吸困难,.,89,膈膨升-影像,膈肌位置明显升高膈肌活动减弱消失甚至矛盾运动心影纵隔移位、摆动邻近肺组织压迫感染胃腔扭转,.,90,Diaphragm Eventration,.,91,.,92,case2,.,93,.,94,case3,.,95,.,96,.,97,.,98,.,99,.,100,膈膨升-诊断,膈的位置升高